Buck, James BURIAL - REMOVAL -TRANSIT PERMIT
Place of Death•
FLORIDA STATE BOARD OF HEALTH
a• County BUREAU OF VITAL STATISTICS
la
n Precinct=__.__ fit
z Cityor Town , GL.i `J�'
NUMBER OF PERMIT
HName of Deceased O• Age or7 Sex W g Color____
Date of Death V- �/
X7 po ,1199_ ` Name of Cemetery or Crematorium
WRemoval to: City Art . GGq State ,�'.r_1�d? �C.t
I hereby certify that I have prepared for buri or other disposition, the body of the above named deceased strictly in
a accordance with the laws of the State of Florida and the Rules and Regulations of the State Board of Health of Florida
n governing the dispositio of d d human bodies.
m • ago.` /Ole,
m Firm Name C" (Signature)
License No._��
'z (FUNERAL DIRECTOR)
a
2 A death certificate having been filed in my office, permission is hereby granted for the burial, transportation, cremation or
placing in vault (cross out words that do not apply) of the body of the above named deceased.
0(Signature) ‘2174.4-. Local Registrar
rc
- 1- If the body is embalmed,the licensed embalmer is required to file an affidavit with the local registra efore Burial-Removal-Transit Permit is issued.
'--Pi The Burial-Removal-Transit Permit must be deavered by the undertaker to the sexton or other person'in charge of the cemetery where burial takes
a place.This Permit must be endorsed by the sexton and delivered within ten days to the local registrar of the district in which burial takes place.If
m there is no sexton in charge of cemetery, the undertaker or person acting as such shall sign the Permit as sexton,write across the face of Permit th
Nwords,"No person in charge"and return Permit to local registrar.
o Body was Cremated on March 2 , 19 4 ,in
(STATE WHETHER BURIED, CREMATED OR PLACED IN RECEIVING VAULT)
• B ynand.'s-._C.rem. :-tQ J CumtettA at___Pe-t;fr_s.b i g_--Be_a.ch City Fl r_ida State.
o.
Q (Signature) C G
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PIONSON IN'"C$ERGE7 '-
t
W If Body is to be Shipped, fill out the spaces below:
a
i Shipping Station. , Florida,for Name of Cemetery
U (STATE WHETHER BURIAL OR CREMATION)
...I (if obtainable) at - - State
W
T. Consigned to Address
o I hereby certify that I permitted the shipment of the above named deceased this -- day of , 19
F (Signature)
0 (TICKET AGENT OR BAGGAGEMAN OR EXPRESS AGENT)
Z Name of Transportation Company
•
Rules of the State Board o `Health of Florida Governing the T ansportation of Dead Bodies
TRANSPORTATION AND DISINTERMENT OF DEAD BODIES wooden box or metal vault;pr+,`ided,that the body will reach its destination within eighteen
om (18) hour,from time of death. f the body cannot reach its destination within eighteen (18)
Rule 1. A Burial-Removal-Transit Permit issued by t -Local Registrar,his deputy orsub- hours from the time of death,9en the body must be prepared as provided by sections (a)
registrar of the registration district in which the death as 'red,or the body was found,must and (hl of Rule 2.The outside-ass may be omitted in all instances when the coffin or casket
accompany each dead body when transported. is transported in hears. fun.r director's vehicle, private vehicle, private railroad car, or
(a) The Burial-Removal-Transit Permit must state t-q place of death,name of deceased, private airplane.A body to he transported by any common carrier must in all instances he en.
sex,color or race,age,and the date of death,th; ate of shipment,the point of ship- eased in a sound coffin or casket"and enclosed in a strong outside wooden box or metal vault.
ment and destination,and shall bear the signatur4.n I title of the Local Registrar
.,ho Rule h In it shipment of odies dead from any of the diseases named in Rule 2,such -
issued the Burial-Removal-Transit Permit. - I mob, shalt not he ar o d by persons or articles which have been exposed to the
(b) The Burial-Removal-Transit Permit shall bear the:signature of the funeral director and infection of the disease, un certified by the local or state health officer as having been
show the license number of the funeral director issued by the State Board of Funeral properly disinfected. ('
Directors and Embalmers for Florida. 0.• Rule 5. No dead body shall disinterred for transportation without the written consent of
Rule 2. The bodies of those who died of smallpox,IxV onic plague,Asiatic cholera,scarlet the State Health Officer.All disinterred remains shall be encased in an airtight iron,steel,zinc,
fever-(scarlet rash,searletiaa),-glanders,srtlirs-, ep ss pidem6e-mt,- ,,.--_per, a:' topper_.al,l.ea'd• iA4d-r46.1 vr_ skey "II-join"-and seams hermetically sealed or-waled by
(infantile paralysis),or measles,shall not be accepted for' nsportation unless prepared in the gasket and all encasedn a stroffg metal or wooden box;or the body placed in a strong coffin
following manner: or casket and encased in an airtight metal vault or outer wooden box lined with not less than a
twenty-eight (28) gauge metal li ing.
(a) Arterial and cavity injection with an approved d._.. fecting fluid.
Rule 6. When dead bodies'}e to he shipped by express,all of the preceding odes shall
(b) Disinfection and stopping of all orifices with abt*apt cotton apply except the Burial-Removal.ransit Permit shall be attached to and accompany the Waybill.
(c) Washingthe body with disinfectant. p _ �..
_ .---,---.-o- .- _ ---._s�F' _.. _—.�_- u 4 -,-_-$Q.4,,7.,.0 i' „,ViA-41.41... a-p,l:a o,shall..a pitpated tL att it,..buz altIt - -
(d) The body,after being prepared in die above meaner,shall be co aced in an airtight see inn •"d i of Rule 2.
iron,steel,zinc,copper or lead lined coffin or casket,all joints and seams hermetically 1
sealed or sealed by gasket and all encased in a strong metal or wooden box; or Rule 8. When a body has bein held fifteen(IS) days from date of death,permission of the
the body placed in a strong coffin or casket and c-used in an airtight metal vault or State Health Officer must be obtained before the body is offered for transportation.
outer wooden box lined with not less than[went fight (28) gauge metal lining. Rule 9. The depths of all grves in the State of Florida must be at least four and one-half
Rule 3. The bodies dead from any cause not specifi n Rule 2 shall be accepted for feet deep with the exception thy);where it is impossible to do so,body may be buried in a
transportation only when encased in a sound coffin or cas t and enclosed in a strong outside manner which is satisfactory to Vical and state health authorities.
t .
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INSTRUCTIONS TO LOCAL RGISTRARS (f the body is shipped by exp-ss,the Burial-Removal-Transit Permit must be attached to the
Waybill,and the receiving ages shall turn it over to the •cafe ing •inbalmee, undertaker.or
Local Registrar,niu t keep a,ufiir lent number of Burial-Removal-Transit Pet-nuts on hand person taking charge of the re ' for final disposition. -
and order additional supplies when needed from the Butu of Vital Statistics,Jacksonville. _.
Burial-Removal-Transit Permits are not to be distributedtin blank among embalmers,funeral Every outside case holding a ead body offered for transportation shall bear at least four
directors or any other persons,but are to be kept by the land registrars. handles and when over five feet and six inches (5 ft.6 in.) in length shall bear six handles,
The local registrar is required to fill out the Burial-R_.oval-Transit Permit which must be two on each side and one on ea i end with approved bolts and lock nuts.
signed by the funeral director who prepared the body for s tpment.
Under no circumstances shalypn agent or baggagemaster receive a body for transportation
INSTRUCTIONS TO TRANSPORTATION AGENT OR BAGGAGEMASTER when fluid or offensive odors are escaping from the case.
The Burial-Removal-Transit Permit should be placed 'n a stout envelope and attached to The coupon at bottom of Bu dal-Removal-Transit Permit should be filled out by transports-
the outer box or case and at destination turned over to the undertaker or person having charge tion agent or baggagemaster at s ipping station and mailed to State Board of Health,Jackson
of the burial of the body. yille,Florida,within twenty-four(24)hours after shipment of body.
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