Thompson, Julia a -° o
R.
0. STATE BOARD OF HEALTH OF FLORIDA
2 .5 County Orange Permit No
R. +s BUREAU OF VITAL STATISTICS
y Precinct One
p 'tea -0 (Write name, not number)
.c) or Removal and Burial Permit
y " Inc. Tow/fin,,, Reg. Dist. No.s7?5 .�..
° c - City orO lan..d0
a Full name Mra.s{U1i8,. ` Q.T11p Qfl ; Age a4. ; Sex.._female.•; Color....Zh1te
: 3 Disease causing death Influenza _-_ _ — -
,,
E v W _ Date of death Feb,25 , 195.2
Q" a ° Removal to G ns Fall —New York , via ttP.7.1rQaSi
so. 7, Undertaker -' :.. a Address Orlando,�'1p,,,
F A Certificate of Death having been filed in my office in accordance with the Laws of Florida, I hereby authorize the
removal and burial of the body of said deceased person as stated above.
c 1.0 Dated June 1,1935 , 19 Registrar's Signature -•-•--
p m
"a Burial Permits must be delivered by the undertaker to the sexton or other persons in charge of- a buri41 ground or cemetery where burial
O C, m takes place. When the body is to be shipped to a distant point squiring the service of a common carrier, in addition to the Removal Permit,
o E 0 the body must be accompanie zby a Transit Label as requir b the State Board of Health. For full par ' rs see Rules and Regulations
•i, ° ^0 governing the trans tati n of dead odies. r
o U . Sexton's Signatur .. . ....... .. ... .. .. ....Dat of Interment
0. c
a 3. tl
m This permit must be endorsed by the sexton eturned t egistrar of his district ,-giving
ten days. If there is no sexton or
y a person in charge of burial ground,the undertaker or person acting a such, shall sign same as sexto date of interment. Write across
F., to , face of permit the words, "No person in charge," and return to Local Registrar of the district in which interment is made within ten days.
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Only the Local Registrar (Deputy or Sub-registrar) may issue a Burial, Removal, or Transit Permit.
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