Webster, Henry a•u+ STATE BOARD OF HEALTH OF FLORIDA
�y County "� .N• BUREAU OF VITAL STATISTICS Permit No.
s~; m Precinct...One.
w, (Write name, not number)
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a›y Inc. •Town Removal and Burial PermitReg. 35v1
0 0. Cityor Qx. en.CI-Q Dist. No
to pci
4.M Full name MX:_._Han y... . W4�'2..g.f e.r ; Age n 6 ; Sex --' ; Color W
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�� Disease causing Death G. .S .;1ra?....1EI.^..O.i�.�.:c.f^_'f;
•n. Date of death P.eb i...15. h , 19.2 •
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Removal to G.2..enri,.-_ ' a..S ._��Y., ,via RRz.l rQ d.
Undertalcer`Tv,L! Address O.I 1idp F` c1
E 1,' N A Certificate of ath having been riled in my office in accordance with the Laws of Flori , hereby authorize the
d bud removal and burial the body of said deceased person as stated above. -. -
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.0 c) Dated Aid; 4 , 19 26 Registrar's Signature._.. ..
o 0 4., i Burial Permits must be delivered by the undertaker to the sexton or other persons i charge of the burial ground or cem-
O w etery where burial takes place. When the body is to be shipped to a distant point, req ing the service of a common carrier,
o in addition to the Re 1 Peri i , th•L•'dy must be C ccom nied by a Transit Label as required by the State oard of Health.
For full particulars s ule� e: .t': g.ve} ng transportation of dead bodies. /�
p▪ v Sexton's Signature.. / - A�Fx� Date of Interment (Gl.,19.
a m This permit must be ind r by the sext and re rned to the Local Registrar of his distric ithin ten days. If there
is no sexton or person in eh a of burial ground, the undertaker or person acting as such, shal ign same as sexton, giving
, pu i- date of interment. Write across face of permit the words, "No person in charge," and return Local Registrar of the dis-
F+ 0 K trict in which interment is made within ten days.
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INSTRUCTIONS TO PASSENGER ACCOMPANYING REMAINS
This Burial and Removal Permit must be filled out by the
Local Registrar of the registration district in which the death
occurred from information stated on the Death Certificate, over
his signature.
The transportation company's agent or baggagemaster 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 this portion of the Transit Permit and attach it to the
Waybill, 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.
The passenger accompanying the remains must deliver this
Permit to the undertaker or person having charge of the burial of
the body.
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.
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