Numan, Carrie Latest Edition 1924 • ,
TRANSPORTATION OF CORPSE
TRANSIT PERMIT
1 B
2LACE,OF DEATH STATE OF WISCONSIN
rown
county Department of Health—Bureau of Vital Statistics
1, Township COPY OF DEATH RECORD
1;•1' OP
• wage Registered No..........................................,..............
w OP 3t Vincent Hospital ...st. . .........Ward)
CitY Greexi. 13.Ety_ (No.................................._......... _—__-_------- ........................ ....................
(If death occurred in a hospital or institution give its......instead of atreet and number)
2 FULL NAME Carrie...Us—SUMS=...................._...................................—...................................
n Be,ly st. Ward' ....(ff. ..J
(a) Residence No. Gree iii""&i,........inirifiti•Wi....
x (usual place of ab e)
W Length of residence in city or town where death occurred Yrs. mos. d,s. How long in 13. S., if of foreign birth yrs. ums. ds.
PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICA.TE OF DEATII
.4 3 SEX 4 COLOR OR RACE 5 ngh%Ergerg4:4000:07)
16 DATE OF DEATH (month, day and year) A 192 8
c.) June
5.1 female white widow
o 17 I HEREBY CERTIFY,that I attended deceased from..70.
1;14 6a If Married,Widowed or Divorced lag ,,,, to .................. 1921 ; that i last saw hfir.4?-alive
on
HUSBAND of 1,...
(or)WIPE of ...
fl
1921.., and that death otourred on the date
• _____
O I . ........ ............,
s above at............m.
,1.41 6 DATE OF BIRTH (month, day and year) Jan. 28-1855
OF DEATH*too as follow r
0° 7 AGE Years 1 Months I Days lf LESS than 1
f.;174 day, ......hours .144.•,•44-1X4-41--4-4 #(7)
g 7 3 4 7 or ..........min. ..... , ............
.... ......... ..................... . ...... .. ......
M 9 OCCUPATION
WW ........ . ....
• (a) Trade, profession or .. ..............
'e•0 particular kind of work
0 A ......... ............ (Duration),../ 7,/, =OS dS• 6....._
(b) General nature of industrY
cc I:14 business, OT establishment in . yr
1.4
Es which employed (or employer) Contributory Aelf -.............,.......... .
;40 condaryr '--
62.A.AZeAti ......„Las...4 /
„E:41 9 EAI raLH.PrL (city or town)
New York ........... (Duration)........ Yrs mos.............dB-
FA \ \ i 0 NAME OF FATHER Chas. Devol IS WHERE WAS DISEASE CONTRACTED,
IF NOT AT PLACE OF DEATH?.............................................................-
g .
r.4 \
11 BIRTHPLACE OF FATHER (city or town)New...Tort....... Did an operation precede death?......................Date of................................
z Z (State or country)
1
E., 2 Was there an autopsy?12 MAIDEN NAME OF MOTHER Matilda Cury
What test conned diAls Ws?.
O 13 BIRTHPLACE OF MOTHER (cat/or town)._
New-York-I (SIGNED) U'..,s, 07 ,_
tj q
(State or countrY)
O 11 s,/192 (Address) )..1i.A..,
1..1 _4.9-1 A.,_,
Es
• 14 Herbert Human
from violent ca state (1)
• Informant State the death, willieggh:oc,idental,suicidal, or homicidal.
O (See reverdditional space.)
(Address) 436 3. Monroe Ave.
;--.
is 6
w 1 File4............4........... 192-/--- r•ef-d;'-i • - - - ... 19
ANE_BURIAL,CREMATION 0,R REMOVAL DATE OF BURIAL
June ? In 8
Registrar. I
,rI. 20 UNDERTAKER ADDRESS
Ei riled , 192 Sub-Registrar , Findeisen GreiSer Co Gr1eer1 saay
________
PE ICE
RMIT OF LOCAL BOARD OF ALTII
June 4 , 19 28
Permission is hereby granted _Louis F. GreiSeT holder of Embalmer's License No 587
to remove for burial from Green Bay to Glens Falls
State of
New York the body of Carrie M. Numan
above described, which has been prepared for transportation in conformity with Rule No....J..-2. of the rules of the Wisconsin State Board
of Health, relating,t the transportation of the dead, printed on lil It back of this permit, and A'gih11-Jf: is hi by ant"sed to accii.,....",931Ysaid remains.
Health Officer.
-
-
The corpse transit label and transit permit must be . • .0.p (.,,d/./,‘Ce;6
Residence,
--c-:
-------- laccurcly attached to the outside cos 7 the shipping und,74ker and delivered
with the body at its destination. When interment takes ..k, •,1: ,,-,
e in Wisconsin the transportati emit,which accompaiss the remains, con-
iP c
stitntes sufficient authority for the burial of the body.
.----- . `'°rII,T;gt
CORPSE TRANSIT LABEL
- License No
. .... ,.„,
Certificate of undertaker 1.$14AG0°.i
'_567
2,...:,...t.
- ody of Carrie me.. Numan
--- ---.„-hoNci;Jk;?,t- m"ME-reliS ,,,,,'d45= .,„„ _
on June 4 , 19z_o_,to be transported
to Glens_Falls ,
, State of New...York in care of ...4 •:-(1-.-In•
has been prepared for transportation in conformity with Rule No. Ir pgq.:::i
of the rules for the transportation of dead bodies, as ado ted publi Is<d_by tlte--IW-i nsin State Board of Health. g
— ! Ft' -:,1,"F,•
0- ,-.•
(Shippin Funeral Director)
, June 4 , io
Green Bay, Wisc.
Address
Station Baggage Agent must enter hereon a descripotfietnheof tii.,:secorpse, the exact route and via what junction points the corpse ticket
or the cads w ' h i held by the passenger in charge 'in•'-`•ii 74"
‘, —
19.2i
No. of Ticket ‘5, )......-,
Form No. of Ticket ' ,...-4.---/
Via
R. R. To
• as 1.-,0.z.•p
Via .
R. R
R R. To R. R. ,-,,,'- -
"‘gso'co
Via R. R.
Via R. R. To ,..,. .ki$5.
R. R. lg.;
' -- .......
Name of passenger in char . ... _ lace o esidensial..." R.
.7 ,...,•,..„
. _
Signed
„AZ- -,-trfCV.,L-..,;.:•••''''......-'-e,4e.,...?Pr..,-!.,„,,,....-e:,.L.....--"L__---•°__ r''' `4,'-','ei.(7
,...,...../...,,......-....,__.Station Agent. ,.,la,o P
........,......::::.1.77
b1 6 1;1 I 0 4 I 4:tie 4 '.....-.'1."1, 3141;14411,411140.
jeliVide Lg144
cillx:504,,i,
RULES OF THE WISCONSIN STATE BOARD OF HEALTH FOR THE
TRANSPORTATION OF THE DEAD
Adopted by the State Board of Health on August 26, 1915, and
Thee uls apply equally to all common carriers and, having been published
duly adopted and official paper on September 14, 191�,
full force ofr laaw, published, have the
properly
To comply with Section 155.01 of the Statutes, the State Board of Health adopts the following Rules for the
Transportation of the Dead.
ItLl `d—A bbar� mmof€iiE and ira5ia;t label ay ruee proper';iealin`au lit3 i�.®s 51'ia`il"'fd "equyrea tor ea-eh—dead
co
body transported by common carrier.
The transit permit shall state the name, sex, color and age of the al deceased, the cause and date of death, the ini-
date of issuance,the sig nature e the aof the undertaker,and route of ithe signaturee and the offici title of o of preparation
officer preparation of the body, the
The transit label shall state the place and date of death, the name of the deceased, the name sofntheghe escortn it or
consignee, the initial and terminal points, the date of issuance; the signature and official title of the officer issuing
the permit shall be attached to the outside case.
RULE 2—The transportation of bodies dead of smallpox, plague, Asiatic cholera, typhus fever, diphtheria (mem-
braneous croup, diphtheria sore throat), scarlet fever (scarlet rash, scarlatina), erysipelas, anthrax and glanders, shall
be permitted only under the following conditions:
The body shall be thoroughly embalmed with an approved disinfecting fluid, all orifices shall be closed with absorb-
ent cotton, the body shall be washed with the disinfecting fluid, and placed at once in the coffin or casket which shall be
immediately closed, and the coffin or casket, or the outside case containing the same, shall be metal or metal lined, and
hermetically and permanently sealed. [Amended February 5, 1924.]
RULE 3—The transportation of bodies dead of any disease other than those mentioned in RULE 2 shall be permitted
under the following conditions:
(A) Bodies dead of any disease other than those mentioned in RULE 2 may be received for transportation when
encased in a sound coffin or casket, and enclosed in a strong outside wooden box, provided they can reach their destina
tion within twenty-four hours after death.
(B) When the destination cannot be reached within twenty-four hours after death, the body shall be thoroughly
embalmed and the coffin or casket enclosed in a strong outside wooden box.
RULE 4—No disinterred body dead front any disease or causes shall be transported by common carrier unless
- __--_anproxpe by al. health authorities having ii!ricilietinn st etca__nlaro_ 9f_i11at label shall be required as provided in RULE 1. *ttternnent; and txa'?sit ^nrrct attd..# pct.
The disinterment and transportation of bodies dead of diseases mentioned in RULE 2 shall not be allowed except
by special permission of the health authorities at both places of disinterment and the point of destination.
All disinterred remains shall be enclosed in metal or metal-lined boxes and hermetically sealed, providing that bodies
in a receiving vault, when prepared by licensed embalmer, shall not be regarded as disinterred bodies until after the
expiration of thirty days.
RULE 5-The outside case may be omitted in all instances when the coffin or casket is transported in hearse or
undertaker's wagon.
RULE 6—Every outside case shall bear at least four handles, and when over five feet six inches in length, shall I
bear six handles.
Rule 7—An approved disinfecting fluid shall contain not less than 5 per cent of formaldehyde gas, the term "em-
balming" as employed in these rules shall require the injection by licensed embalmers of not less than 10 per cent of
the body weight, injected arterially in addition to cavity injectiora, id twelve hours shall elapse between the time of
embalming and the shipment of the body.
h �icer'rt; Be' urmit, and label as described herein, with these
RULE 8—The attached form of death cvrtifltze, i''
rules printed thereon, shall ha-used in thi;State for the shi .�64 nQ�t°,�yies as herein provided.
tier RUL(membraneous bodies'
ap),those dead feverl (scarlatina), plrash, meas_tic cholera, yellow fever, typhus fever, diph-
shall not be accepted for transportation to medical colleges. tes, erysipelas, glanders, anthrax or leprosy,
RULE 10—The bodes of those dead from puerperal fever, tuberculosis,
mentionoti in RULE 9, iay be received for transportation to medical colleges wtyphoid fever, or any other diseases-not
of the body with di-. :sting fluid, the closing of all orifices, the wrapping of thee prepared for shipment by the washing
---,-. of it in a sheet, soaked in bichloride of mercury 1:500. Bodies thus prepariody in absorbent cotton and the enclos-
or casket encased in a strong outside wooden box with needles. All such bodiesd must be enclosed in a soundwitjhn
sixty hours after death. As soon as received at the medical college the body must be at once carefully'embalmed by
injection of a preserving and disinfecting fluid into the blood vessels.
RULE 11—When disinterred bodies are removed from one cemetery to another, or from one part off a cemetery to
another part of the same cemetery, and transported by private conveyance, the written consent of the health officer of
the district where the body is buried and the health officer of the town,village or city where the body will be reinterred,
shall be sufficient authority for the removal.
PENALTY. Section 156.07 of the Statutes provides that any person who shall be guilty of the violation of any of
the provisions of this act, or who shall violate any rule or regulation prescribed by said board, for the preparation,
embalming, shipping or burial of any dead human body, shall be guilty of a misdemeanor, and upon conviction thereof
shall be punished by a fine of not less than ten dollars nor more than fifty dollars or imprisonment in the county jail
not less than ten days nor more than sixty days.