Kennedy, John Order by Number
Form 5-V. S.
S
TRANSPORTATION OF DEAD HUMAN BODY
7 FOR USE ONLY WHEN BODY IS TO BE ,TRANSPORTED OUT OF NEW JERSEY
- UNDERTAKER'S CERTIFICATE
I hereby certify that the body of J.eh•••Il••. nne•dy••
e ardi>�l � � ' .1► on Feb 3...1927 19 -i
who died of Z
rig
been prepared for transportation in every particular as req-ired by law and the Riles of the`Department of Health m
of the State of New Jersey. And I do hereby apply for a TRANSIT PERMIT to convey said body byAltt.A...&.•R,tit3i.1••• _
(Railroad or otherwise.i
from ... .Q.efitia3 f.f..L a in the GO
Bergen New jersey, to Cleo Falls in the County 0
County of ® m
�'I8. York. and that il.)4.ftm E.O.AX1 aY xi
of in the State of...+.. . ... -1
be authorized to accompany said body in such transit. n
zell
v ,.,.., kety Jer ey tl�ie
Dated at .........�.tt.�!t County of -. .t���:j��'r.i�.t� " �• �-I
i
February A. D. I9.gr..' .. e,...0 ...,1 ....` ;';„... 'Aertaker mai
day of 1 8 Z Address of
•
Place of Burial.Pi> ,el... iaw.•.Cemetery.••G].eu. Walla Undertaker Ridzawa*&.L.•J•. OD
•• �m
(Name of Cemetery and C!ty or County.) F 1 •Y. -i
I-4
Station Baggage Agent must enter hereon a description of the corpse ticket, or check the exact route.and via what Junctional Points the corpse ticket or check mW
reads, which is held y ,the p ger in charge o s the corpse.
1 DatA = 1 19 ®m
t, '` to State of .n
From ?C
No. of Ticket Form No. o,f Ticket ipS
om
Via R. R. To x{
To� � R. R. �
Via ... ..i t D
R. R. To X
Via T o M
R. R.
Via
R. R. To ix t -i
Via
Via
R. R. To p
-I
m
Name of Passenger in charge Place of residence 2
Station Agent.
Signed
No coffin-box should be received for transportation from which any fluids or offensive odors are escaping.
w. TRANSIT PERMIT"
Bergen e.s,d.aliff.•lak1e:
State of New Jersey, County of ii (Township or City.) O
A Certificate of Death, signed by.W.w.B+t.>A.QV4 0+• Y••• physician, having been presented to and filed with o s
i.0 04.011�f„•ja tp in the County of `q'.rgielt New Jersey,
me, Registrar of Vital Statistics, for.... (Towns r City,...) rrm
setting forth the S-Olowing facts; Name of deceased....... . ....{...... . -m
Age 66 i eats Months I� Days; Place of death a' +�* Dag t
Date of death F.011•••I .I9 Cause of death. e.a. rf.i g.emOxigfi'1't R Qo
And an Undertaker's Certificate, signed by C tC+,va inbUrgh Undertaker, having also been presented o 3
to me, setting forth that said body had been prepared by said undertaker for trarisportation in every particular as required C.
, Rules of the Department of Health of the State of New Jersey: � i 9t4� f Lakec
CT
• • o convey said body by....A•Z1. .R...&...RaiX, from
Idlid rio l:Se.)T(•Y• in the State of ..NOW f '.k '
At ate,
to
•• •n such transit. 0.
3
!_
Rules regulating the transportation of dead human bodies issued by the Department of Health of the State
1. The transportation
except a license of bodies dead of no for the transportation
is first obtained from
Asiatic cholera, of New .krsey,
in accordanceTet trtatiOn of oe bodiesdeadm State Department yellow fever,
with the written requirements dead the said partment of Health, typhus fever and
no license the quiro which shall diseases each will be issuedor from bubonic dead body until an inspector saidor officer a said IIe is is not tocase be it is shown department,
2 The bodies of remain unburied longer specified and made that said bodies have
human g r than a part of license. beenprepared' and
bY any common carrier beings dead of seventy-two hours_.
(a) Remove all unless said bodies shalanl firsts h have
whatsoeverrted
beings
other than the
part each of the dead bodyave been treated as follows;
in number one
'� Ib) Fill—allbichloride of mercury and apply rule
should ) used and withs cotton woold x to of ply onio hea t surface a solution of shall not de asfollows:
hich has first been1,000 parts of bichloride of
(c) The should firmly packed. saturated._ water.
mercury prepareddy
than two inches in be placed in a coffin H'ith the follows:
thickness. After the bodyor casket mercurial solution and(d) The coffin body orh casket has been and should TeSt allowed to day ri l not less
When
the dead bodycontaining dead bodyplaced in the coffin,upon coffia layer of sawdust
scarlet is to re theheied longer should be placed in outer
box,sho stronglyld be securely of or t absorbent materialborids
fever, remain an outer closed, less
chicken- than made 3• Afterh P°8, measlesb and seventy-two hour; seven-eighths
metal-lined box,lteing prepared e1'Ysipela� urs, and in all galas boards.
as re cases of diphtheria
and said metal-lining required
drule 2, the dead body, ' membranous croup,
Hosed to the infectionCOmmunicabje air-tight by solderingthe coffin or casket,
that said of the disease diseases al] theshould be
persons unless a certificate a body should notjoints and seams.*
plaed inh a substantial
or articles have been rendered free has been .
5. dead bodyissued be accompaniedbr b
age, place of des trans from infection. by the local boardby Persons or articles to accompany �, causePorted out of the Stateof health; or its which have be
the body, of death, and accompanied authorized been ex-
and shall Every not be if any person Point to musts behe cpanied by a transitofficer, showinga ,mutilated inis theo authorized, body is topermit,
6. No the process of beingaThe transit be transported, showing ename
� ��.- attached. permit shall be and of deceased, date
veiling the local "�—shall be offeredsecurely name of the of death,
ifs of the board of health, for trans Y attached to the person authorized
nod box, disinterredst 0 which the f nor unless transportation to anyoutside of the coffin-box
and all said body
consent common carrier
annex by bodies board
and seams in for such transportation
unless the
cali buried. disinterred metal-lining is to be consigned. l disinterred
ed bodies disinterment has
7. Dead human shall be soldered, `411 s plaerdehavei been obtained frombfen authorized e rich are offero bodies which are Bodies placed shall be enclosed in the health
ns, and shipment prepared in receiving vaults shall an air-tight
ori-
olu-
no such solutions at somein New Jersey for transportation be treated ' gat metal.
shall be mero pointn Within the State, shall noott°beation across in the
within or same
into the blood vessels or cthe
cavities with injectionsState by co
or beneath the of arsenical or carrier
. Permits for disinter --- , _ ` . surface of the or other poisosjotrs' and
9 In procuring meat of dead human bodies ty skin of any such dead
axed in % transit permits forbe void after
accordance with the rules disinterredseventy-two
abed Permitsof the human t offs ehe Ytwo hours have ela se
othern ro uri or transit or miteRem for Permits State dead Department heh,ndertaker swear p d from date o
cal re r within or without are not to lie shall f issue.
registrar the State,its be used or affirm that the
or the State Departmentas authority remains have c the Health,� Trenton,
ton entitled "Transit
for the removal of been
cases where bodies of Asp Trenton Transit the date and t are forwarded by ' N. J.
Permit fordisinterred bodies
tial public carrier, DisinterredtotheBody"h from
point, and is designed
the bodyyPshould be secured
deli
preparationdecomposition hu gn b,Jj es enable the heal be expected. noticeesishould uld be to d from
garnet theof deadman health officer his notice sent by telegraph
of the remains transportation by public carriers es provideddestination
r° take all necbY, or in t health