Jackson, Fred COUPON No. 2.
Registered No -- No.of Permit
To be detached as per instructions on the back of this coupon.
ligame7eitap9',.. 42.,,,,,,,
bate of Death2-1-'—/9).-7 Cause of D az.eir azzA.e- --001-,,r_.1
rfue-4444 sif
Place of Death AL/ 9-"k"Z/734.1, )4_../....,,,,i , Cemetery It--s- -c-a 7,.2;
Date of Shipment.j.)-e--e---- 2-6----/f"17 City or Town.."2--641 CALefl•
Hour of Train Kliti—
dr—i...54ell
State of
Signature Board of ealth Official. 112gt___
Shipping
Embalmer.
COUPON NO. 2.
This Coupon to be detached ONLY when required for record in cities or towns, otherwise tot
be filed with the local board of health or town clerk where the interment is to be made, and by the
superintendent or person in charge of cemetery.
t_ s
C1.11V4. •
TRANSPORTATION OF CORPSE.
THE COMMONWEALTH OF MASSACHUSETTS.
Transit Permit No.
PERMIT OF LOCAL BOARD OF HEALTH. •
This Permit must be properly signed and presented, with Undertaker's Certificate, to the Railroad, Express or other
Transportation Agent before a body catlbe shipped.
In the of ..9^-140 n County of State of Massachusetts,
(City, To or Village.)
on this day of 19...z...7 Permission is hereby given... -2T�J s7c �
holder of Embalmer's Certificate, Registered No � ,to remove for burial at_.01.--1 County of
!i v'at.a, State of 21, .. the body of .
lli
who died at.1�„s}'vt�.-f�7" ounty of.._A'�'�f��2`"- -e/ State of Massach ,on the day of
191'1..,at `r'r/'M.,aged..71 years months days,the cause of death being..a- C2 Ll�iC.� ... ... .._ ._..
ram-U
which is a t /ft .... disease requiring shipment under Rule No._. of the Rules of the Massachusetts State Board of
Registration in Embalming for the Transportation of the Dead, as printed on the back of this permit.
Name of person in charge of transit. /
(Official Title.) ,
This Permit and Coupon must be detached and delivered to the Person in charge of the Corpse.
•
TRANSPORTATION OF THE DEAD.
RULES OF THE MASSACHUSETTS STATE BOARD OF REGISTRATION IN EMBALMING FOR THE
TRANSPORTATION OF THE DEAD.
RULE 1. The transportation of bodies dead of smallpox, Asiatic cholera, yellow fever, typhus fever or bubonic plague is absolutely
forbidden,except after cremation.
RULE 2. The bodies of those who;have died of diphtheria(membranous croup),scarlet fever(scarlatina,scarlet rash),measles,glanders,
anthrax or leprosy shall not be accepted for transportation unless prepared for shipment by being thoroughly disinfected by(a)arterial and cavity
injection with an approved disinfectant fluid, (b)disinfecting and stopping of all orifices with absorbent cotton, and (a) washing the body with
the disinfectant,all of which must be done by a`registered embalmer,holding a certificate as such. After being disinfected as above,such body
shall be enveloped in a layer of cotton not,less than one inch thick,completely wrapped in a sheet and bandaged,and encased in an air-tight zinc,
tin,copper or lead lined coffin,or iron casket, all joints and seams hermetically soldered,and all enclosed in a strong,tight wooden box; or the
body,being prepared for shipment by disinfecting and wrapping as above,may be placed in a strong coffin or casket,and said coffin or casket
encased in an air-tight zinc,copper or tin case,all joints and seams hermetically soldered,and all enclosed in a strong outside wooden box.
RULE 3. Bodies dead of typhoid fever, phthisis, puerperal fever,erysipelas, tuberculosis, or other dangerous communicable-diseases,
other than those specified in Rules 1 and 2,may be received for transportation when prepared for shipment by filling cavities with an approved
disinfectant,washing the exterior of the body with the same,stopping all orifices with absorbent cotton,and enveloping the entire body with a
layer of cotton not less than one inch thick,and all wrapped in a sheet and bandaged,and encased in an air-tight coffin or casket: provided, that
this shall apply only to bodies which can reach their destination within forty-eight hours from time of death. In all other cases such bodies shall
be prepared for transportation in conformity with Rule 2. But when the body has been prepared for shipment by being thoroughly disinfected
and arterially and cavity embalmed by:aa registered embalmer,the air-tight sealing and bandaging w'th cotton may be dispensed with.
RULE 4. Bodies dead of diseases that are not contagious,infectious or communicable may-be-received for ranspor ation when encased
in a sound coffin or casket and box,or enclosedl in a strong outside wooden box: provided,they reach their destination within forty-eight hours
from the time of death. If the body cannot reach its destination within forty-eight hours from time of death,it must be prepared for shipment
by filling cavities with an approved disinfectant,washing the exterior of the body with the same,stopping all orifices with absorbent cotton and
enveloping the entire body with a layer of cotton not less than one inch thick,and all wrapped in a sheet and bandaged,and encased in an air-
tight coffin or casket. But when the body has been prepared for shipment by being thoroughly disinfected and arterially and cavity embalmed
by a registered embalmer,the air-tight sealing and the bandaging with cotton may be dispensed with.
RULE 5. In cases of contagious,infectious or communicable diseases,the body must not be accompanied by persons or articles which
have been exposed to the infection of the disease, unless certified by the health officers as having been properly disinfected; and before selling
passage tickets, agents shall carefully examine the transit permit,and note the name of the passenger in charge and of any others proposing to
accompany the body, and see that all necessary precautions have been taken to prevent the spread of the disease. The transit permit shall
specifically state who is authorized to accompany the remains.
RULE 6. Every dead body must be accompanied by a person in charge, who must be provided with a passage ticket, also red check
ticket, first section to be retained by railroad agent issuing same, second section to be given to person accompanying body, and third section
(with cord) to be attached to box containing corpse; also a transit permit with undertaker's certificate, name of deceased, date of death,age,
place of death, cause of death, the point to which the body is to be shipped, and the name of the person or persons authorized to accompany
the body. The undertaker's certificate and paster shall be detached from the transit permit and pasted on the coffin box. The transit permit
shall be handed to the passenger in charge of the corpse. The first coupon shall be detached by the official in charge of the baggage depart-;
ment of the initial line.
RULE 7. Every disinterred body,dead from any disease or cause,shall be treated as infectious or dangerous to the public health, and
shall not be accepted for transportation unless said removal has been approved by the board of health; and,a11 such disinterred remains shall be
enclosed in a hermetically sealed (soldered) (if out of State) zinc, tin or copper lined coffin or box. Bodies deposited in receiving vaults will •
be treated and considered the same as buried bodies,unless to be interred in same cemetery.
RULE 8. The bodies of all persons who die in Massachusetts,that are to be shipped by public conveyance,even though the initial point
of such shipment be a railway station outside the State,must be prepared and forwarded in accordance with the regulations in force in the State
of Massachusetts.