Brenenstuhl, Harry CZ 0
a Or .ge STATE BOARD OF HEALTH OF FLORIDA
o p, County Permit No.
p'+a One BUREAU OF VITAL STATISTICS -
i~.[ re Precinct
a• a a (Write name, not number)
cl
or •
+• °, Inc.Town
�.›� City or Orlando Removal and Burial Permit Reg. Dist. No 3501
o• .0�
�M Full nampr Harry E. Brenenstuhi ; Age 42 ; Sex M ; color W
Disease causing Death Embolus, following disorticulation of left arm at
�.0 shoulder Date of death Dec 19th 19 26
• E° L ke Geor d N.Y. Railroad
• 0 Removal to ,via
H� Undertaker . `� Address Orlarda, Fla.
H a A Certificate of eath having been bled in my office in accordance with the Laws of Florida, I hereby authorize the
a saw removal and burial of the body of said deceased person as stated above.
�g az
w 'o Dated Dec 22nd , 19 26 Registrar's Signature... ... . . Vi Y(.,..
o a y, Burial Permits must be delivered by the undertaker to the sexton or other persons charge of the burial ground or cem-
a p+a etery where burial takes place. When the body is to be shipped to istant poin re firing the service of a common carrier,
o 5 in addition to the Rem v a Permit, the bod mu a om Tr resit el quire by the St to Board of Health.
-N O For full particulars an ul n., ies. ; N
o u Sexton's Signature ate of Interment i�� �^G 7"�....,19
0, a This permit mu be find sed tie sexton and returned to the Local Registrar of his district within ten days. If there
is no sexton or per n in charge of burial ground, the undertaker or person acting as such, shall sign same as sexton, giving
b e k.0 I date of interment. Write across face of permit the words, "No person in charge," and return to Local Registrar of the dis-
E+ a I trict in which interment is made within ten days.
aa - ---- -------------------_..- -------_---- ------------- -- -------------I.
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.
I i The transportation company's agent or baggagemaster must
detach this portion of the permit and hand it to the person
tauthorized to accompany the remains.
`,,, If the body is shipped by express, the express agent must
\_- I detach this portion of the Transit Permit and attach it to the
i Waybill, as it must accompany the remains to its destination.
!
I. 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
t ) the body.
' c} This Permit authorizes the burial of the body of the deceased
l`. named on the reverse side of this Permit at any place in the
/ State of Florida.