Transportation Permit141 11-10-49 1031
For Use Only by Minnesota Embalmers
MINNESOTA DEPARTMENT OF HEALTH
TRANSPORTATION PERMIT
Identification of Remains
Name of deceased Lary Livingston
40647y,n
Color W Sex F Age 45 Date of Death k -Ar. 3rd, 19 51
Place of Death St. Paul, Minn.
(City, Village or Township)
CAUSE ❑ communicable or ® non -communicable disease
Attending Physician Dr. C.A.Ingerson Coroner
Address 918 City Hall St. Peul,(2) Minn.
Embalmers Certificate
I hereby certify that the remains have been prepared for transportation
in accordance with the regulations of the Minnesota State Board of Health
relating to the transportation of the dead; that the body has pA or has not
❑ been embalmed, and I further certify that I [2F am or ❑ am not a Sub -
registrar of vital !na4:ie�_
LicenA No 2550
ignature)
A. E, HENRY FUNERAL HOME
536 { (Address)
ST. PAUL 4, MINN.
NE 2844Permit of Re"W45
(To be signed by the Local Registrar or a Sub -registrar)
Transportation, by means of Hearse is permitted
(Conveyance)
for the removal on March 6th 19-5-1 of the remains from
St Paul,linn to Chanhassen, ;_inn.
(State)
for disposition. OWL��e
Ynr. 6th, 1951
(Signature)
(Title)
Person in Charge of Conveyance
(Signature)
NOTE: This permit, issued pursuant to the provision of Regulation 35, is to be sled, to-
gether with 'the burial -removal permit, with the cemetery sexton at destination or with
the health officer in cities that have local ordinances requiring burial permits by him in
all cases.