Burial PermitMedical
Place of burial
Name ofcam r Vi
Undertaker ddress
A certificate of des having been filed in ce in acc anc� a wiEh the
laws of Minnesota, I hereby authorize the _ of the
body of deceased person as stated above. In case of death from•a dangerous com-
municable disease, the burial or removal must be conducted according to the rules
of the state and local board of h
Date
rar o yp
1 v
OOfficialial TkIc Title
*Write "Burial" or oval"as the se may Burial permits most be delivered c the
m-
nndertaleer [o the s oval
mri
[ n. Removal perits Vat bea given to the agent of transportation om-
pany, and attached byy Lim to box containing body. Sub -registrars will write Sub" before the
words Regimar of 7hatbs" and "Licensed Embalmer No. below, always giv-
ing number of license. Five or imprisonment for receiving a—Conal without permit.
Received 19 Sexton
Name of cemetery Address
Tble focus tsar be and fur dlavternlmt-rdatocmut b :conedusen with Regoladan n
66
4Z[w3
This permit serv� a burial permit at destination
accept where local ordinance requires local permit
raA
DEATH STATE OF MINNESOTA
County
REGISTRAR'S
Town hlp
^�/�
_ ___ NI.12 t
_—
v�oR
-Permit for Burial or Removal
City_
grr eath 19
FHII n e
Sex_
Place of birth e
Medical
Place of burial
Name ofcam r Vi
Undertaker ddress
A certificate of des having been filed in ce in acc anc� a wiEh the
laws of Minnesota, I hereby authorize the _ of the
body of deceased person as stated above. In case of death from•a dangerous com-
municable disease, the burial or removal must be conducted according to the rules
of the state and local board of h
Date
rar o yp
1 v
OOfficialial TkIc Title
*Write "Burial" or oval"as the se may Burial permits most be delivered c the
m-
nndertaleer [o the s oval
mri
[ n. Removal perits Vat bea given to the agent of transportation om-
pany, and attached byy Lim to box containing body. Sub -registrars will write Sub" before the
words Regimar of 7hatbs" and "Licensed Embalmer No. below, always giv-
ing number of license. Five or imprisonment for receiving a—Conal without permit.
Received 19 Sexton
Name of cemetery Address
Tble focus tsar be and fur dlavternlmt-rdatocmut b :conedusen with Regoladan n