Miller, Louis c E County Osceola STATE BOARD OF HEALTH OF FLORIDA
g . Precinct BUREAU OF VITAL STATISTICS _ C'/
(Write name. not number; - e7 oA
o p- a or Permit No
Inc.`or 4.P� - Removal and Burial Permit .t4- o L
o City.___. Reg. Dist, No
8 Full name Louts L,Mi11er Age 56-5-25g, Male . Color White
2.2 sad Cause of death Cosonasy. S cle.oaia C.o.sonaL.y Thzoaboaia
.= o Date of death 12/28/3.7._.. 19 Removal to ._.G1e.na....Fa1.la,N.aJ
73 I
E o m Via - - . . Funeral Director's License No .....
62 s 6 • St..Cloud,.Fla
- o Funeral Director. .. Addross
e If the body is embalmed, the licensed embalmer is required to file en affidavit with the local registrar before burial. removal or transit
I— " o permit is issued. 1
-c u• 3 A Certificate of Death having been filed in my office in accordance with the Laws of Florida. I hereby authorize the removal and
o burial of the body of said deceased person as stated above.
....
`t
" /_y `' �a-4.Pam'
c g, 9 Dated Ate �O lay-Local Registrar's Signature
a
oc i Burial Permits must be delivered by the undertaker to the sexton or ofons in charge of the burial ground or cemetery where burial takes place.
a a ss When the body is to be shipped to a by the point, requiring of the service* on corner, in addition to the Removal Permit, sp body mutt be xcom•
a a ponied by a Transit La I as r lied by the State Board of Health. or I ciders see Rules and egulations governing the transportation of deed bodies
�° /k * (J a
-
y/
s o o (V� /rI /s e.�F ' y 9t.0 s- c Sexton's Signature "whit {,(„u)_.L.AAr t -- . �, __ .... ... ate of Interment.. I
This permit must be endorsed by the sodon and retinae erthe Local Registrar of his dis 'd within ten days. If then is no sexton or person in charge
of burial ground, the undertaker a person acting es such, shell sign sane as sexton, giving date of interment. Write across face of permit the words, "No
WWI 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.reaistrerl may issue a Burial. Removal. or Transit Permit.