Loading...
Burial PermitPLACE OF DEATH ,5 This hermit serves for a ori5el remit at dem.., except where local ordinance mQuires local i,erm.- STATE OF MINNESOTA REGISTRAR'S No. 3W Permit for Burial or Removal Full nn. IAge _YM Sex t7rdPla of bird Disease causing death - Medical Proposed Ateof I. attendan rial or rem ival 19 `,% Place of burial, remova or crematio (city, Vil. or TF1w ) Conveyance u. Name of Cemete Undertake ddressC - a„— A certificate of death having been filed in in ice in acyprdance with the laws of Minnesota, I hereby authorize the .Y of the ( urlal or Removal•) body of deceased person as stated above. In case of death from a dangerous communicable disease, the burial or removal must be conducted according to the rules of the state and local board of health,. _ — /l Official Title *Write "Burial" or "Removal' as the use may be Burial Permits must be delivered by the undertaker to the sexton. Removal "=its must be niveu to the anent of tramportatiao com- pany. and attached by him to box containing body. Sub•mi,trars will write Sub" before the words Recutrar of Death.' anal Lice and Embalmer No. below, always siv- im, numher of license. Fiae or iaaorisoomev[ for reeeiviva a body for burial without Permit. Name of cemetery Address This form may be used for disinterment-aeiatamut in aeardsmee with Raalalien 27.