Burial PermitCounty,xz�!•v STATE OF MINNESOTA
ISTRAn'S
Township ............................. REG
No..................
village .. ............ ...... .
city., ........ P mit for Burial or Removal
at of DeafJ .................29Z.111
Ful Name........... .. .. .............a9e..... .............yrs.
Disease causing death.... ....... .... ...... ..... ..... .....
Medical1 ,� Proliesed date eF
attendant ............burial or ree>nval ......- ......
Place of Buria ........ >rz e . �..
Place of remove�.....:.................................
UY
Undertake , ofa%ra/
' ....Address ..........................................
A cc 'tate of death having been fled in my office in accordance with the taws
of Minnesota. I hereby authorize the— _of the body
(Burial or Removal)
of said deceased person as stated above. In the case of death from a dangerous
communicable disease, the burial or removal must be conducted according to the es
of the State and local board of hem. .� n �� _ ,
Dated................................19...........................................
-Write 'Muriel" or "Removal" as the case may be. Burial permits [abet be deliv-
ered by the Undertaker to the Seaton. Removal permits must be given to the Agent
of Transportation Company, and attached by him to box containing body. Subregls-
trars will write "Sub" before the works Registrar of Deaths- and T.tcensed Em-
balmer No.--" below, always giving No. of License. Fine or imprisonment for
receiving a body for burial without a permit.
The Sexton or person incharge of cemetery should,glve date of receipt and sign
wa
his name below, then forrd this permit to the local registrar of the town, village
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 Registrars Burial Permit it most 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 of cause of death, and then
to file the complete 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 Registrars 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 properpreparation of the -lady for transportation,
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 Registrars Removal Permit forms part of it or has previously
been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUBREGISTRARS.
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, under the same restrictions as those govern-
ing its issue by a registrar, except in cities having local ordinances governing burial
and removal permits. 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 within ten days.