Burial Permit57,/
PLA OF DEATH STATE OF MINNESOTA
County
' REGISTRAR'S
TowneW No. e 9
Vilna �' Pteroit for Burial or Removal
Date
Disease causing death - =F " ��
Medical Proposed date o
attendant / oriel or rets Val O 1936
Place of burl
Place of remo Via _
Undertaker Address
A certificate of death having been Sled in in ce in arordance with the
laws of Minnesota, I hereby authorize the �f the
(Yana, or ttemovw)
body of deceased person as stated above. In case of death from a danger-
ous communicable disease, the burial or removal must be conducted according to
the rules of the State and local boa f health
Ragiatrar --
Dated _ 1
official Title
"Borrel" 'Bmuovel" u ti. race may be. Burial permits must 6e delivered by the
Undert er to the Sexton. Removal permite moat be given to the Agent of Tranaportation Company.
and attached by him to box containing body. Sub•reg6trvrs will write "Sub" before the words
"Registrar of Deatba" and "Licensed Embalmer N. " bebw, always giving No. of
License. flue or imprisonment for receiving 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 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 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, 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 possession before he issues
the burial or removal permit, and the death certificate most 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.