Burial PermitLor 93.4
county -ad_. STATE OF MINNESOTA
Ts"8"ip__________ REGISTRAR'S
Village.:#_ No--------
------------------------------ Permit for Burial or Removal
Date p1 Death--_ _ 19�-_-.
Full Name---- Q'�A f' ✓ i-r�
at_S�e_4/rI ----Ale ---- yrs.
Disease causing death' # /----�--•tr_
Medlin! l Pre�sdlak e�� i ii
attendant J" -_r__-T-----Mrlal or remonl J elk �u7
Place of BetW_----�t_*_t�t1�p1��-=FC�?eYY/t-_
Place of remewt via
liedertake �_t� Address p((�_t,---- ----�_.
A certificate of death having been gd in my sem accordance with the laws
of Minnesota, I hereby authorize the. Qr. 1 /.w / .....of the body
(iiMsl or Reta".v)
of said deceased person as stated above. In the case of death from dangerous com-
municable disease, the burial or removal must be conducted according to the rules of
the State and local boards of he
Dated.- =h `&7 1 - s
------ -----------
•Write "Burial" or •'Removal•' en the case may be. Ru l Title
Y permits must be delivered
by the Undertaker to the Seaton. Removal permits must be given to the Agent of Trans-
portation Company, and attached by him to box containing body. Subregistmrs will
write ..Sub" before the words "Registrar of Deaths" and "Licensed Embalmer No-" be-
low, always giving No. of License. Flue or imprisonment for receiving a body for burlial
without a permit
NOTICE TO
This blank constitutes a Registrar's "Burial Permit" or "Removal Permit," accord-
ing to the manner in which it is filled out by the Registrar.
.As a Registrar's Burial Permit, it 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 t_ -.e personal and statistical facts required by law, to
ppresent it to the attending physician for his certificate of cause of death, and then to
5le the completed certificate of death with the Registrar of the district where the
death occurred Sextons should not permit the interment of a body unaccompanied
by a regular Burial or Removal Permit.
As a Registrar's Removal Permit, this blank must be obtained from the Registrar
as above, presented by the undertaker to the Agent of the Transportation Company,
and be attached by the latter to the box containing the body. The Removal Permit
is not a Transit permit The latter, supplied to undertakers by the State board of
health, provides for a statement of the proper preparation of the body for transporta-
tion, signed by the Health Officer, and contains 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 has
previously been issued by the registrar of deaths.
1fSSIIE OF PERMITS BY SCBREGISTBARI
A licensed embalmer, holding an unrevoked certificate of authority from the State
Board of Health to act as subregistrar of deaths, can use this blank for the issue of a
gpermit for burial or removal to himself for a death occurring in a township or vil-
ge,
but not city, under the same restrictions as those governing its issue by a reg-
istrar. The certificate of death, fully made out in ink, and signed by informant and
physician, must be in his possession before issue of permit, and the certificate must be
personally delivered to the registrar of the township or village where death occurred
on or before the third (3rd) day of the following month without fail.