Burial Permitq6}A 3
County
Tow hip
OR
Village
OR
City_
DEATH
This permit serves for a burial permit at destination
e�acept whero local ordi—ce requires loin permit.
STATE OF MINNESOTA
REGISTRAR'S t,
No. _3VV -
Permit for Burial or Removal
EMM, i M t — t
Disease causing des
Medical Proposed date of
attendan {u *a] or rem vat 937_
Place of burial, remo crematio
city.
Name of em a V.
Undertaker ddrese
A certificate of death
—having been filed in ce 1n aco ance with the
laws of Minnesota, I hereby authorize the of the
(laarfal or Hemoval')
body of deceased person as stated above. In case of death from a dangerous com-
municable disease, the burial or removal must be conducted according to the rules
of the state and local board of h 1t
IdlW&(R rar o eaths
Date 1 AAA31
Oficial Title
-Write "Burial" or "Removal" as the case may be. Burial permita must be delivered by the
undertaker to the sexton. Removal permits must be ffiveo to the agent of transportation com.
pany, and attached b him to box containingbody.Sub-registers will write Sub" before the
words Registrar of Deaths" and "Licensed Embamer No. below, always giv-
ing number of license. Fine or imprisonment for receiving a nnal without permit.
Received 19 Seaton
Name of cemetery --Address—
This
form may be ter dlsivtermmt-rofnmrmmt in accordance with Regulation n.