Haviland, Foster ti Form 88-1935 TRANSPORTATION OF CORPSE
_ (Afways yg write with black ink)
*tate of Maine
BUREAU OF HEALTH
CERTIFICATE OF DEATH
Place of Death—Town or City . Portland, Maine
No. 16.3 Pleasant Avenue
Street,Locality,Institution or Hoapital
Full Name Foster....Lane , aviland
03 How Long a Resident 25 years Previous Residence
c'b
p, PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH
Married, Single,) DATE OF DEATH (month,day,and year) 19
a. Sex M Color , Widowed or) ..
I Divorced) HEREBY CERTIFY, That I attended deceased from
a.- Deceased was Husband of............i l e Ford • • . ..._.Z., , 19..:'.1.., to '' . ....._... 5 , 19..3.7,
.2 2 Deceased was wife of t I last saw h alive on ' ...."i....__...:./.3._.. 19 31
� Ce
w Date of Birth: Year1871 Month 7 Day 24 and that death occurred, o. the`date stated above,
Age:Years 65 Months 11 Days 21 at Q P.m.
G *Occupation R.?ti,._ .d-.So.la P5.•Qking
o•� Industry The CAUSE OF DEATH was as follows:. ._._
cPlace of Birth 01 ens Faf.1.5.4 N e y X,QX. ..... :...._.... .. __............
w 0 Name of FatherRog er Haviland (duration)..._......... _. ._...mos._ ` de.
�. Birthplace of Father Westchester, N* •CONTRIBUTORY ..�-Ste+-,,,,-a
•A (Secondary) -
r Occupation of Father Druggist (duration) yrs mos. de.
Maiden Name of Mother Mary Jane Lane Where was disease contracted if not
Birthplace of Mother .....N.Qw 1 Q.r.k.,.....N.. Y.... at place of death? -�--
*Exact statement of occupation is very important. Example: Did an operation precede death?... ..Date of
Instead of Laborer,write Farm Labors Name of operation...._................_._......._..__...._..._.........._.................................
Hay & Peabody Was there uto ? ...._.PrO..._.... ..
(shipping Funeral Director) (Signed) ,M.DDorti9 •
, �. ;..e Address • S'S( G..�..
(Ad Ad dress - — —
PERMIT OF TOWN CLERK AND *HEALTH OFFICER
This Permit with above Certificate, must be presented to Initial Baggage Agent and delivered with body at
destination July 19 1937
_
Permission is hereby granted to remove for burial at Glens Falls, New York the body
of Foster Lane Haviland ,above described,if prepared in accordance with the laws
of this State. If contagious or communicable, state name of person who is authorized to accompany the body.
f :: Town Clerk
*The above permit is hereby approved. Health Officer
*To be used when the approval of the health officer is required.
Detach above portion at this perforation.and hand to passenger in charge,to be delivered to the undertaker at destination. If burial is made
in this State the sexton or other person superintending,must send this permit and certificate to the State Bureau of Health in ten days.
-- Detach at this perforation,and securely attach this label to the outside case.
CORPSE TRANSIT LABEL License No 4
FUNERAL DIRECTO' 'S CERTIFICATE. Register No.
as
I (or we) hereby certify that the accompanying dead body of
.i!
to be transported to Glens Fall* State of....N ew York•,,,..in care of R,..?...7 '.y .7i, X'..e.S.`a ,..e.ia.m'
has been prepared for transportation in conformity with rule No,...3_._.............._...of the transportation rules for corpses
in this State . Consig,ned to; Ei.: l-I, ,r .,.Reg n ..&.....attaff-ard, In.c...
- - �1ray & Peabody
Shipping Funeral Director
July 19 1937 Address ......P,.Q.r.tia.act.., ISLa.iu.e.
Station Baggage Agent must enter hereon a description of the corpse ticket,or cheek the exact route and via what Junctional Points the corpse ticket or
check reads.which is held by the passenger in charge of the corpse. July 19
Date193 '
From Portland,, Maine to Glens Fal1 State of....ligw Y.Q,ric
No. of Ticket Form No. of Ticket.......................................
Via R.R. To......
Via R.R. To......
Via R.R. To
Via.. R.R. To
Via R.R. To
Via R.R. To
`, Name of passenger in charge...RAiJ.W Y ExR.r.e.5.•AgeneVlace of residence
\ Signed Station Agent
` _
STATE OF MAINE
Rules and Regulations of the Department of Health and' -•
Welfare for the Transportation of the Dead
BUREAU OF HEALTH
Under authority conferred by Chapter 1,Public Laws of 1933,the following rules and regulations
are hereby made by the State Department of Health and Welfare:
Sec. 1. A copy of the original death certificate, signed by the attending physician, a permit..
from the town or city clerk or local registrar shall be required for the transportation by common car-
rier or private conveyance of the bodies of the persons who have died in this State.
A. A transit label signed by the shipping funeral director and the initial baggage agent,printed
on strong paper, supplied by the Bureau of Health, shall also be required for the transportation by
common carriers.
B. The permit of the town or city clerk shall authorize the transportation of the body of the
person described in the physician's certificate. The shipping funeral director shall state on the ship-
ping label how the body is prepared and the local baggage agent shall state thereon the route and the
name and address of the escort. The copy of the death certificate and the permit of the town or city
clerk shall be given to the escort to be delivered with the body at destination. The shipping label
shall be securely attached to the outside case. If the body is sent by express,the copy of death cer-
tificate and the permit shall be attached to the express way-bill,and delivered with the body at the
destination, and the shipping label shall be attached to the outside case.
Sec. 2. The transportation by common carrier or private conveyance of bodies dead of small-
pox,plague,Asiatic cholera, yellow-fever, typhus fever, diphtheria, (membranous croup or diphthe-
retic sore throat),scarlet fever, (scarlet rash or scarlatina), anthrax, encephalitis (epidemic), menin-
gitis (cerebrospinal, epidemic) poliomyelitis, and typhoid fever, (including paratyphoid fever) shall
be permitted only under the following conditions: the body shall be thoroughly embalmed at once.
with an approved disinfectant fluid, all orifices shall be closed with absorbent cotton, the body shall
be washed with the disinfectant fluid, and placed at once in the casket which shall be immediately
closed. The casket shall be enclosen-a strong outside box made of good sound lumber, not-Tess .
than seven-eighths of an inch thick; all joints must be tongued and grooved, top and bottom, put
on with cleats or cross pieces all put securely together, and be tightly closed; provided, however,
that caskets containing embalmed bodies may be shipped to points in this State in tight ordinary
casket boxes; provided further, that the casket or the outside case containing the same, in which a
body dead of smallpox,plague,Asiatic cholera,yellow fever or typhus fever has been placed,shall be
metal or metal lined, and hermetically and permanently sealed.
When desired,a metal casket or a metal or metal lined outside case may be used for a body,dead
of any disease.
ere Sec. 3. The transportation by common carrier of bodies dead of any disease other than those
mentioned in Section 2, shall be permitted under the following conditions:
The body shall be thoroughly embalmed and the casket enclosed in a strong outside box as is
provided in Section 2. It shall be also provided that interstate transportation of bodies dead of any
disease, other than those mentioned in Section 2, shall be permitted by private conveyance if the
body has been thoroughly embalmed.
A. Bodies dead of any disease not mentioned in Section 2,which are to be transported by pri-
vate conveyance within this State, shall not be required to be embalmed,but must be buried under
the direction of a registered undertaker or a licensed embalmer.
Sec. 4. No disinterred body, dead from any disease or cause;shall be transported by common
carrier unless approved by the local health officer having jurisdiction at the place of disinterment,
and a transit permit, and transit label shall be required as provided in Section 1. The disinterment
and transportation of bodies dead of diseases mentioned in Section 2 shall not be allowed except upon
special permission of the health authorities at both the place of disinterment and the point of desti-
nation. All disinterred remains for transportation by common carrier shall be encased in metal casket
or metal lined boxes, and hermetically sealed; provided that bodies in a receiving vault when pre •
-
pared by licensed embalmers, shall not be regarded as disinterred bodies until after the expiration of
thirty days.
Sec. 5. The outside case may be omitted in all instances when the body is'transported in a
hearse or funeral director's coach or wagon.
Sec. 6. Every outside case shall have at least four handles, and when over five feet six'inches
in length shall have six handles. All handles attached to outside wooden boxes shall be fastened with
— — -
•• Sec. 7. An approved disinfectant fluid,as required in Section 2,shall contain not less than five
per cent of formaldehyde gas. The term "embalming"as implied in these rules ahall require the in-
• jection of an approved disinfectant fluid by a licensed embalmer,of not less than ten per cent of the
body weight for bodies of persons dead of diseases under Section 2,injected arterially in addition to
cavity injection.
Sec.8. The attached form of death certificate,town or city clerk permit,and label as described
herein,with these rules printed thereon,shall be used in this State for the shipment of bodies as herein
provided.
Whoever violates any of the provisions of Sections 1 to 8 inclusive shall be liable to the penalties
provided by Section 31 of Chapter 1, Public Laws of 1933.
Approved by the Advisory Council of Health and Welfare February 28, 1934.
•
•
,