Burial PermitPLACE OF DEATH STATE OF MINNESOTA
C REGISTRAR'S
Township C.LP`:Q..d No.
OR
Village. ........................ . .. ....................
OR Permit for Burial or Removal
city......................................................
Date,of Death ..........
Full7 ......... 7 ........ yrs.
Sex... 1
........ ..... Place of Bhth. ....
.
Disease causing
Medical at
attendant) burial or
-,e ...........
Place of Burial ..... ............... ...... ................... Jc
Place of removal .......................................... via ... .......
Undertake;,(4.f.N:�P-i,..�,.i-,.*C,.�..�Address....
A certificate of death having been filed * office l accordance with the laws of
Minnesota, I hereby authorize the...................T3:.:1..-r. . ............. of the body
Ghtriall or Removal*)
of said deceased person m stated above. In case of death from a dangerous communicable
disease, the burial or removal most be conducted
local board of health. actor to the rules of the State and
4-t9j ......................................................
Dated... ...... ............ .... * ...... * ........
Official Title
-Write "Burial" or "Removal" as the neat may be, Burial permits meet be delivered by the Under.
takertutheSe.to.. �Zptno,ral permiqmuss begiwn to the A of an attached
by him to box containing body. So write "r r att..
and "Licensed Embalmw No.. ............. always gi4vbin'geNTf..'of=Licer'�'%FiZ�t�j.pd'iw=.t
for receiving a body for burial without permit,
Received...........
Name of Cemetery..
............19................................................Seaton
................................ 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-
pany, and be attached by the latter to the boa containing the body. The Removal Permit
os 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
br the Health Officer. This Transportation Permit also contains a Removal Permit.
10 Tranait Permit can be i swd-by any He31th 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 PERMITS BY SUB -REGISTRARS
WA licensed embalmer, holding an unrevoked certificate of authority from the State
Board of Health to act as a sub -registrar of deaths, has 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 possc .on 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 m a city is the health officer; in
a village, the recorder; in a township, the town clerk: