Thompson, Leroy County .6211./a2r----
STATE BOARD OF HEALTH OF FLORIDA
Permit No. ,,-2 f /
Precinct ...AA"--)
Bureau of Vital Statistics
(Write name,not number)
Reg. Dist. No 3 s5—e)
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Inc.Town
City
or
BURIAL OR REMOVAL PERMIT
66...elt.----.2
Full name 7.1. 4s..., Age._7_2_ Sex__WI Color-2,/,/
Disease causing death C1-z-e•-:t_ Date of Death
Place of burial._____
Or
Removal to. 4-4,74, _ 72e.„.4.4./7 C&Z via71.„
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Undertaker .
1 a.....1_,..-A.._.,-44/ .o.---3.-z,e4 ,74-Zt-21Address-
A certificate of death h ving been filed in my office in accordance with the Laws of Florida, I hereby authorize
the of the body of said deceased person as stated above.
(Burial or Removal)
Dated / .g- -- .2 cf"-- Registrar's signature Agef C
/3. 41z.,_„s4.4.,:c:L__._
Burial permits must be delivered by the undertaker to the sexton or other persons in charg., the burial grcun emeterywhere burial takes
place. When the body is to be ghipped to a distant point,requiring the service of a common carri n addition to the r val permit,the
, body must be
tion of Dead Bodies.accompanied with a transit permit as required by the State Board of Health. For full particulars •e Rules and Regula iortos Governing the Transporta-
444.2,.
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Sexton's signature
Date of interment (tli i_9._ 6
— ,
This permit must be indorsed b ' re 4- 1;-• e i • district within ten days. If there is no-;?;L—exton or person in
charge of burial ground,the undertaker r person acti as suc s 1 si . . iving date of interment. Write across face of permit the
words, No person in charge,"and retAfin to Local Registrar of the district in which inte ent is made within 10 days.
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