Burial PermitPLACE OF DEATH
TO
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OR
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City- ....... ...... ....................
LOT 33.—z
PLACE
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STATE OF MINNESOTA
REGISTRAR'S
No......
for Burial or Removal
Date of I?eath....,C
Full Nai
-A
e!
Sex . ..... -A� . ....
.. ... Place of
..... ..........
Disease causing death ...,.--, ... 77. - ,
Medical ............ ...... ...... ..... N
tj
�� Proposed date of
attendant .............. burial IQ 7-e
Place of Burial.. t;,;�
............
riace emo-
. .. .... ..... ..
A certificate of death with the . laws .. of
Minnesota, I hereby authorize filer]' M office ac
..... .. _._...........of the body
of said deceased person a, stated above. In R..0 a dangerous communicable
disease, the burial or removal must be du
local board of health. rd -9 to the rules of the State and
.......... .................................. . ..........................................
Date .5� 197c.. I
'Write -Brial" "Removal" he 0 ffirial litle
tak to the Sr - &4= mgt crgiT --Ythh. Wt permiioe ts most del -red by the Under-
b.YdhiT4..bd Embalmer S-b-g'ft— -11 write "S -b" b0N,r. the and attached
.. t 7 1 f.D.tb
for recti,ius a body for burial without - ...... - hdow- always 9'vhW No. of License. Fite
Received ........................19... . ...
- ....Sexton
Name of Cemetery................._.._...........Address.. .
..
380-11-IC18-501d. e.-....,..,..,.....
NOTICE TO UNDERTAKERS
This blank constitutes a Registrar's `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
any 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 compplete 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 Registrar's Removal Permit, this blank must be obtained from the Registrar,
W stated above, presented by the undertaker to the Agent of the Transportation Com-
pany, and be attached by the latter to the box containing the body. The Removal Permit
is not a Transit Permit. The latter, supplied to embalmers by the State Board of Health,
provides for a statement of the proper preparation of the body for transportation, signed
Yyy the Health Officer. This Transportatron.PerWit also contains a Removal Permit.
No Transit Permit can be issued by any Health Officer, or accepted by the Agent of any
Transportation Company in Minnesota unless a Registrar's Removal Permit forms part
of it, or bas previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUB -REGISTRARS
A licensed embalmer, holding an unrevoked certificate of authority from the State
Board of Health 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 governing its issue
by the local registrar, except in cities and villages which have 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 physicima, must be in sub-
registraes posses9on before he issues the burial or removal permit, and the deathcertifi-
cate must be delivered by the sub -registrar within five days to thelocal registrar o
the
district where the death occurred. The local registrar in a city is the health officer; in
a village, the recorder; in a township, the town clerk.