Burial Permit«/, .
PLACE dF DEATH STATE OF MINNESOTA
Count9 ——xgAlepin
REGISTRAR'S
Township_ ;Ft .0nel� r ling No. 63A
vil Re — krmit for Burial or Removal
C,t,
Date of Death March 31 19 32
Full Name &dward Kelm Aae 37 yra,
Sex Yale_ _ _ place of Birth Minnesota
Disease causing death Multiple Sclerosis
Medical j H.B.Fralic Proposed date an
attendant Q6.0. in Charre burial or removal A r1 g 32
Place of burial Chanhassen. Minnesota
Place of removal oet.l lm.Hosp.Yvlaliinnya hearse
Undertaker Fl�rnn & VARKAIr. _ Address Minneapolis ,Minn
A certificate of death having been Sled in myoffice in accordance with the
laws of Minnesota, I hereby authorize the—=VInsI -- _ —of the
(Burial or Removal-)
body of deceased person as stated above. In case of death from a danger-
ous communicable disease, the burial or removal most be cocted according to
the rules of the State and Ipftpboard of healtlY
var ratPP-S—miga��'6�sa�7.r.1.O
-. - (Basistrar -vol -Deaths)
Dated Apr' 1-- - 19 2 _ Sud-isais+_r
(NRTi e
-Write "Burial^ or "Removal" as the rase may be. Burial permit. must be delivered by the
Undertaker to the Sexton. btemoral permits must be given to the Agent of Transportation Company.
and attached by him to box containing body. Sub-registrars will write "Sub" before the word.
"Registrar of Deaths" and "IA ensed E belmer No. _— below, always giving No. of
Uceme. Mme or imprisonment fur reeeivivg a body for burial without permit.
Received_-----19— — Sexton
Name of Cemetery_ _ __ Address
I66T-9-3-26-2M
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 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 the personal and statistical
facts required by law, to present it to 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 Trans-
portation 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 embalmers
by the State Board of Health, provides for a statement of the proper preparation
of the body for transportation, signed by the Health Officer. This 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 Registrar's Removal Permit forms part of it, or has previously
been issued by the Registrar of deaths.
ISSUE OF PERAHTS BY SUB -REGISTRARS
A licensed embalmer, holding an unrevoked certificate of auth _tzam 4v,
State Board of Health to act.p.s.a tub- remotes* vot-deathgg, Iii— a right to issue
i:ia-to-Mustuna] or removal, under the same restrictions as those
governing its issue by the local registrar, except in cities and villages which have
a local ordinance requiring that all burial permits and removal permits be issued
by the local registrar. The certificate of death, fully made out in ink, and signed
by informant and physician, must he in sub -registrar's possession before he issues
the burial or removal permit, and the death certificate must be delivered by the
sub -registrar within five daya to the local registrar of the district where the death
occurred. The local registrar in a city is the health officer; in a village, the
recorder; in a township, the town clerk.