Burial Permitt7 :: t ! I
C"fity--------------------------- STATE OF XMNESOTA4•i- 36"3
Torttshlp- ----------------------- REGISTRAR'S
ffinNo.--------
�' "" "" """ "" Permit for Burial or Removal
Date -at Death_-�1-- --_L-T------------ 190.__.'P.
Full Name �o r�vu�---------------------------------Age-- 7S ---yrs.
Disease causing death __Q
�___ -
x�.7 - ts.eLs 2z±c-------------------
Medical -- - - Proposed date of
attendant }._,_RgQ6urialorremoval}"
Place of Burial___P_-2______�_'lu�.."
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Wace of removal
P
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-
nderaker , [._�-Address_B__F5_
A ce Ificatr 6- a =f&ath having been filed in my office in accordance with the -laws
of Minnesota, I hereby authorize ................. of the body
(Burial or Remoaal•)
of said decea - person as stated above. In the case of death from a dangerous com-
municable di ase, the 6vrial or removal must be conducted according to the rules of
the State a d local boards of health.i„
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-----`----"--(Bexliirer of lw ikci-----------------------
Dided.
[[�� r- q c� F ic`.- -R
Omolsl Tlile
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-Write eRadar' or "Removal- as the ease may be. Burial permits must be delivered
by the Undertaker to the Sexton. Removal permits must be given to the Agent of Trans-
portation Company, and attached by him to box containing body. Subregistrars will
write "Sub" before the words "Registrar of Deaths" and 'Licensed Embalmer No.=' be-
low, always giving No. of Licenw. Fine or imprisonment for receiving a body for burial
without a permit.
NOTICE TO UNDERTAKERS.
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 +ained by the undertaker before any
disposition is made of the body. It is the duty qf th�e undertaker to have a certificate
of death properly filled out with the personal a$_t", stical facts required by law, to
present it to the attending physician for his certificate of cause of death, and then to
file the it
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 remilar Burial or Removal Permit.
As -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 X)rt of it or has
previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUBREGISTRABS,
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
permit for burial or removal to himself for a death occurring in a township or vil-
lage, 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 belore the third (3rd) day of the following month without fail.