Burial PermitPLACE OF DEATH
County Township. /.. .........
OR
Vi age.._ .. .. ... ...........
OR
City
STATE OF MINNESOTA
- REGISTRAR'S'
,No ........
Permit forial or Removal
................................................ , Date of Death..... a(- e,/q..G
...............19.11
Full Name.)40. a`-8.........yrs.
Sea.... 111UL....... ......... Pladee of Birth._..lYf O/...?/ �...............
Disease causing death........ ! 4 2..�.,.....
t%L
Medical � pp � Proposed date off uu ; f.
attendant G <C i , rremovZ-Q1a.ld.19/..�
Place of burial
Place of removal Emelt
Undertaker.&... ....... Address ... fv-.CdL� .
^ilf fly
A certificate of death having been filed in y office in accordance with the laws of
Minnesota, I hereby authorise the ............... ..:..W11M_..........
..... ..of the body
of said deceased person as stated above. In case of death from a dangerous communiceble
disease, the burial or removal must be conducted according tp the rules of the State and
local board of health.
/_.. .. ........_cCrC 1z ::.._..........._.._...
Bswsrar Bea.thsi �—+
Da.ted..�%.C:%. 1p.-..19 /...............................................................
Official Title
' V[ite. "Burial" or "Removal as the erase MU be. Burial nermits most be dellverM
or
Received __..._..191.._ . .— ......................... ._..... Sexton
Name of Cemetery ...............................Address................................
4
'4T TO UNDERTAKERS
This blanL- constitutes a Registrars "Burial Permit" or "Removal Permit" according
to the manner in which it is filled out by the Registrar.
As a Registrar's Burial Permit, this blank must be obtained by the undertaker before
my disposition is made of the body. It is the duty of the undertaker to have a certificate
of death properly filled out with the personal and statistical facts required by law, to
present it to the attending physician for his certificate as to cause of death, and then to
file the complete certificate of death with the Registrar of the district where the death
occurred. It is illegal to bury a body in this state unless it is accompanied by a regular
Burial or Removal Permit.
As A Registrars Removal Permit, this blank must be obtained from the Registrar,
as stated above, presented by the undertaker to the Agent of the Transportation Com-
pany, and be attached by the latter to the box containing t}u:lw`iy. The Renmval.Perrnit
rs nota Transit Permit_ The t=++er, supplied to embalmers 6y the State Board of Health.
pruvides for a statement d the proper preparation of the body for transports*ion, sigrred
by the Health Officer. This Transportation Permit also contains a Removal Pennrt.
No Transit Permit can be issued by any Health Officer, or accepted by the Agent d any
Transportation Company in Minnesota unless- a Registrai s Removal Permit forms Irv[
of it, or has previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUB -REGISTRARS
A licensed embalmer, holding an "revoked certificate of authority from the State
Board of Hmlth to act as a sub -registrar of deaths, has the right to issue this permit to
himself for burial or removal, under the same restrictions as those govern n.�
its issue by the local registrar, except in cities and villages wh;ch '-a-,,-
a local ordinance requiring, that all burial permits and removal permits be issued by the
local registrar. The certificate of death, fully made out in ink, and signed by informant
and physician, must be in sub -registrar's possession before he issues the burial or removal
permit, and the death certificate must be delivered by the sub -registrar within five days
to the local registrar of the district where the death occurred. The low registrar in a
city is the health officer; in a village, the recorder; in a township, the town clerk.