Burial PermitPLACE OF DEATH STATE OF MINNESOTA
County. ............. Carver ..REGISTRAR'S
.......... .
Township...._...::Chenhaassn....... ............... No..._...----_...._........_.
OR
Village.................................................
OR Permit for Burial or Removal
City......................................................
Date of Death......... Ay.ril,2a.................19
Full Name ... ....'%thi.lda... Kelm ..................... Age....... U............... yrs.
Sex...... I'mai................ Place of Birth..N.113 R................................
Arterio clerosis
Disease causing death........................................................................
Medical u A Proposed date of 1 31
attendant}...... gh........ .. � burial or removal ......y........19........
Place of Burial ......�7 a av,ser,.town„CerhetM ..............................
Place of remoT4.... ....................................via...
urkhart Chas -a; �•iiiri: ...
Undertaker............ `........................Address......................................
A certificate of death having been filed office in accordance with the laws of
Minnesota, I hereby authorize the................................................................of the body
of said deceased person as stated above. In case of death fnompa dangerous communicable
disease, the burial or removal must be conducted according to the Xules of the State and
local board of health.
...................................................................
.....................
(RegiRrar of ths) ....................._..
Dated..........ARr ..9..1931.... t.......
Official Tith,
'Write "Burial" or "Removal" as the cau may be. Burial pwn to rout be deBveted the Under-
taker to the &e too. Removal permim must be given to the Arent of Tmnspormtion Co. mny. and attached
by him to box containing body. Subreg;stnn will write ' ub" before the words "Registrar of Deaths"
and "Ltcxnsed Embalmer No..../...sS..5T.8.': below, always giving No. of License. Fine m imprisonment
for receiv.ne a body for burial without permit.
Received........................ 19................................................ Sexton
Name of Cemetery..................................Address..............................
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 Transportation Com.
parry, and be attached by the latter to the boa 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&ealth Officer, vcsccepted by the Agent of any
Transportation Company in Minnesota unless a Rt%lbLraWs &ar ovai re aat. f� =i
of it, or has previously been issued by the registrar of deaths.
ISSUE OF PERMITS BY SUB -REGISTRARS
" A licensed embalmer, holding an unrevoked 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, most be in sub -
registrar's possession before he issues the burial or removal permit, and the death certifi-
cate 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.