Burial PermitW
Lai X19.'
PLArf
OF DR&M STATE OF MINNESOTA
County....... .�, .: REGISTRAR'S
Township.................................... .
No........... _...........
villa"___ .................
Permit for Burial or Removal
e of
FullN _.....Q.. ........-a rC/.... ....Age.....
��
Sea�cvt�.-...Place oflBirth -.......
�j -- .........
Disease causin"eat�.Q2f
MedicaljProposed date oft
attendantl . burial or removal) ........... .... 19 .....
Place of bririal._y............ ....�....'.
............
Place ofr al..... .
..... via........."
.
Undertake .....
................. lfLss....��'J�/� .....
A certificate of death having been filed in my office in accordan-%*tb the laws of
Minnesota, I hereby authorize the.. ....................................... of the body
... .........................
Uri
of said deceased Person as stated above. In case of eathfrom a dangerous communicable
disease the burial or moval must be conducted according to the rules of the State and
local board of heal
Dated...... ..yD
19 .. �,, : t::. ........... ...... .
•Write .. Gs 1 Title •.
urial" or 'Removal" m the case may be. Burial permits must be delivered by the U der -
taker to the Se#un, Removal cer*nifs must be given+ta,tye eat of Transqppooartwat,pi�o�ny Com lumY. and attached
by him to boa containing body. Subrmistm. will write " ab^ helot, tx , ••Registrar of Deaths••
end "Licxmred Embalmer N. ................_......... below. always giving No. of Five or imprisonment
for receiving a body for burial without a permit
Received....,%AjP,A 0...191j..... .O.Yl�r�.—n. .C'. Sexton
Name of Cemetery. Address 11(441 4z -t
3e-6-29-16—wcrs F. now CO., rr. eaut
NOTICE TO LNDERTAKERS
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'- Burial Permit, this blank must be obtained by the undertaker before
any disposition is rade of the body. It is toe duty of the undertaker to have a certificate
of death properly illled, out with the personal and statistical facts required by law, to
present it to the attending ph sician for hi. 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 Transportation Com-
pany, and be attached by the latter to the box containing the body. The Removal Permit
is not a Transit Permit. The latter, sopplvd to embalmers by the State Board of Health,
by the Health Officer. Thisrarlsportation Peron also contains a Removal Permit.
No Transit Permit can be issued by any Health Officer,, or accepted by the Agent of any
Transportation Compin any
issued Minnesota
y the regi Rerar of ur'sdeaRemoval Permit forms part
of it, or has previously
ISSUE OF PERMITS BY SUB -REGISTRARS
A licensed embalmer, holding an umevoked certificate of authority from the State
Board of Health to act as a sub -registrar of deaths, bas the right to issue this permit. to
himself for burial 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 be in sub -registrar's possession before be issues the burial or removal
permit, and the death certificate must be delivered by the sub -registrar within five days
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.