Burial Permit33.3
SACK OF DW"TH STATE OF MINNESOTA
County ..../i.!.T-rr...�..:,... REGISTRAR'S
Township...- .............. No... -_..J'._..
Permit for Burial or Removal
OR
Village.
OR .. _
City...........................
` /
_Date of D . .. .R-4,._. .ia._...-................19.Ih
Full Name .... A"','. ,,:._�' ��P.d�r�.. ek....yrs.
Sex... i c f .4&..... _ _ PlaceBirth...... F c J....,. C / .. _......
Disease causing death./40...�t�e.,Ce.`�1.�
Medicall A,n� Proposed date of
attendantl. .. '�` removalf;?s....,Yfi1916
Place of burial..__ {�
..
— Place —�--
of removal.. n. -. - .via ........... .. ......_:....
Undertaker..f--,-C./2Rr dress..
A certificate of death having been filed ' my office n' ccordanoe with the laws of
Minnesota. I hereby authorize the .................. .........................of the body
orSempvaiy
of said deceased person as stated above, fn case of death from a dangerous communicable
disease, the burial or removal must be conducted according to the rules of the State and
locat board of health.
(Registrar or Deaths) ...... y
Dated..�ll.? ..+Y-..19/sa................................................
...............
as M case may De. Ifurlai permits must be de119ered
Undertaker to the Sezton. Removaipermits must be given to the Anent of Transporta-
ompeny. and attached by him to boa containing body. SubreeL4trars will write Sub"
Lhe words "Re�stxar of Deaths" and "licensed Embalmer No.___ _. _' below. always gb
. of IAcense. Flue or imprisonment for receiving a body for burial without a permit.
Received-.. ..... ....... ... _191 ... _ ......................................Sexton
Name of Cemetery.... - _ ..... Address.......................
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 most be obtained by the undertakes before
any disposition is made M 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 W 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 Registrar's Removal Permit, this blank must be obtained from the Registrar,
as stated above, presented by the undertaker to the Agent of the Transportation Com-
liany, and be attached by the latter to the box containing the body. The Removal Permit
7s not a TrgnSit Petmit T atter suonlied to embalmer' b}-�the State Bnard of Health.
P
rovides for a statement o[ the proper preparation of the body -for tramporfation, signed
byy the Health Officer. Tliis Transportation Permit 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 Rcgistra 's Removal 1'cnnit forms cart
of. it, or has 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 govern M
its issue by the local registrar, except in cities and villages wh;ch
a local ordinance requiring, that all burial permits and removal permits be issues 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 suh-registrar within five days
to the local registrar of the district where the death occurred. The local rrgistry in a
city is the health officer; in a village, the recorder; in a township, the town clerk.-