Farwell, Charles STATE OF NEW HAMPSHIRE
DEPARTMENT OF VITAL STATISTICS BURIAL PERMIT
N. H., .G1.411.. ' 3. .193 S.--
?ateVA-(4e
Permission is hereby givenLC.--4 Vsr,. .
to remove t e remains of 74A-14-4-4-2-- lit.
from , ,2. 74•
to /(1)...e..4.4_4L c7cf-t4e, • 72 . , for interment in
!(-€4,4) Cemetery, t.„5-; , 19 Date of of Death, - 3 191) IS"...Age, 4year '
, / months3°days.
Place of De , (--4(4-4 2.2'21-• No. 3°
Street, "(-4-4.4-4-4-4-4-"- AL I."". Ward,
Cause of Death etit. 4444- y A4-1-- 4-44.-12-
Contributing Cause, P .
Medical Attendant, )'1,t ' a
It
This permit does not in any way release the undertaker, or person acting as such,from the
requirements of the regulations of the State Board of Health governing the transportation of corpses,or
from the rules or orders issued by the boards of health for the protection of the public against infections
and contagious diseases.
-',9•1- ex, (70'
No. --,,n4r/ kbatt i . t345-1,---tes, Local Registrar.
THIS CERTIFIES that the condition of this Permit have been
lawfully corn • ith.
...,w,
, Undertaker.
[ove..]
Extracts from Chapter 173, Public Statutes
SECT.6. No INTERMENT OR DISINTERMENT of the dead body of a
ji human being, nor deposition thereof in a tomb or vault, SHALL BE MADE
WITHOUT A PERMIT, nor otherwise than in accordance with it. No
undertaker or other person shall assist in, assent to, or allow an inter-
ment or disinterment to be made until a permit has been obtained. It
shall be the duty of every undertaker or other person having charge of
a burial place, who shall receive the permit, to preserve and return it
to the clerk of the town within six days after the day of the burial.
- Sect. 11. Any person who shall neglect or refuse to perform a duty im-
. posed upon him by the provisions of this chapter, shall be fined not exceed-
ing fifty dollars for each offense,for the use of the town in which the offense
as committed,and it shall be the duty of the registrar of vital statistics to
enforce this section.
1 No interment, disinterment, deposition in a receiving tomb, or re-
moval therefrom, of a dead body, can legally be made without a permit.
N. A body deposited in a receiving tomb may be removed therefrom for
interment in any cemetery in the same or adjacent town or city, upon a
permit issued by the proper local authorities (town clerks in towns, the
board of health in cities), provided the removal is by private conveyance.
'j deng is to taransported other
thanIf asa abovebody stepositated,d orin bya public
receivi carr
tombier (railroad)be
, permit must be
obtained of the State Board of Health, also in accordance with Rule 8
W of the "Official Order Concerning the Transportation of the Dead."
• Bodies dead of scarlet fever, diphtheria, or other dangerous corn-
municable disease, must not be placed in a receiving tomb unless they
have been previously prepared by a licensed embalmer in accordance
\.. with the requirements of Rule 2 of the "Official Order Concerning the
Transportation of the Dead."
Bodies that have been buried must not be disinterred except in
accordance with a permit issued by the State Board of Health, and
also by the proper local authority.
Blank application for permits will be furnished on request to the
cti State Board of Health.
L This permit must be signed and returned to the clerk of the town
or city in which the death occurred, within six days after burial.