Pust, William -
Dade
t4 m County _ STATE BOARD OF HEALTH OF FLORIDA
°' Precinct Bureau of Vital Statistics Permit No.19G
a
61 3 (Write name, not number) 11Oy
d Inc.Or TownRemoval and Burial Permit Reg. Dist. No.
o c city" �18�I i
my-I Full Name William Pust ._ Age ' Sex Male Color white
yam" Strangulation of bowel April 30 1919 .
Disease causing death Date of Death s •
6'cs° Glens Falls N. Y. via Railway
p, S,� Removal to
F. Undertaker •w• •H• Combs CO Address Ma.astli Fla.
FA certificate of death having been filed in my office in accordance with the Laws of Florida, I hereby authorize the
o removal .nd burial of the body of said deceased persoi RS-stated above. 4------_
May, 1• 1919 • 19 Registrar's signature �' a _
o a o Dated =� *- -
S S Burial permits must be delivered by the undertaker to the sexton or other persons in charge of the burial ground or cemetery w "fiurial takes
place. When the body is to be shipped to a distant point; requiring the service of a common carrier, in addition to the removal ermit, the body
cu must be accompanied by a transit label as required by the State Board of Health. For full particulars see Rules and Regulate s Governing the
ai-i rn Transportation of Dead Bodies.
p,aa) a) Sexton's signature
Date of interment 19
ol 0 d This permit must be indorsed by the sexton and returned to the Local Registrar of his district within ten days. If there is no sexton or person
;.q in y o in charge of burial ground, the undertaker or person acting as such shall sign same as sexton, giving date of interment. Write across face of
E-+ c0 ) permit the words, "No person in charge," and return to Local Registrar of the district in which interment is made within 10 days.
f
INSTRUCTIONS TO PASSENGER ACCOMPANYING REMAINS
This Burial and Removal Permit must be filled out by the Local t i
Registrar of the Registration District in which the death occurred from \ A
information stated on the death certificate, over his signature. 1/'
The Transportation Company's Agent or Baggage-master must detach
this portion of the permit and hand it to the person authorized to
accompany the remains.
' If the body is shipped by express, the Express Agent must detach thisIrP, \
portion of the Transit Permit and attach it to the way-bill, as it must
accompany the remains to its destination. The receiving agent to turn
over this permit to the receiving undertaker, or person to whom the
body is delivered.
Ss:1 N
The passenger accompanying the remans must deliver this permit to
the undertaker, or person having charge of the burial of the body.
& \\kt,
This permit authorizes the burial of the body of the deceased named
on the reverse side of this permit at any place in the State of Florida.
NI
•
e