Burial Permit.3
Medical
attendant Lt
Place of burial. �_re��ffo
Name of camel
Undertaker
A certificate of death
laws of Minnesota, I hereby
T.Q.
This permit serves for • burial permit at destination
except where local ordinance requires local permit.
STATE OF MINNESOTA
REGISTRAR'S
No.
Permit for BurialorRemoval
body of deceased person as stated above. In case
municable disease, the burial or removal must be
of the state and local board of hepAtbgp n
date
in AcWance with the
of the
Remo )
from a dangerous cem-
i according to the rules
Date
' trar of )
1
Official Tide
'Write "Burial" or "Removal" as the ease may be. Burial permits must be delivered by the
undertaker to the sexton. Removal permits must be van to the agent of tranaportatiov com-
pany, and attached by him to hoz crovtaimng body Sub -registrars will write Sub" before the
words Registrar of Deaths" and "Licensed Embalmer No. below, always gin -
in; number of lice
me Fine or imprisonment for receiving a or burial without permit.
Received 19 Sexton
Name of cemetery Address
This form mar be ossa for dbintarmmt-rNntw t is accordance with Regulation I3.