Stitchman, Max Place of Death BURIAL - REMOVAL -TRANSIT PERMIT
r r_ FLORIDA STATE BOARD OF HEALTH
i County (�.�GJL BUREAU OF VITAL STATISTICS
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a. Precinct
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Z City or Town I--/__1-4*y/ - . -e NUMBER OF PERMIT
gName of Decea ed 71-_ Q Age.13._Sex_ Color_Wk
714 Date of Death-__ __ •(2._1 ,19�_L/ .�////�Name of Cemetery or Crematoriumt.y,
wRemoval to: City 7 L.4 O fl_ _Q.IL�ral State _!-/. - •
I hereby certify that I have prepared for burial'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 H alth of Florida
governing the disposition of dead human bodies. ,� ,,
mFirm Name 41_-__ _ &k (Signatu l�lf, / License No.
7 (FUNERAL DIRECTO
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a A death certificate having been filed in my office, permission is hereby granted for the lsuraal, transportation, ezem t—fir
pl ^s,-in-.cult (cross out words that do not apply) of the body of the above named deceased.
ri (Signature) e_-•--u --~_-{ — _Local Registrar
_-If the body is embalmed,the licensed embalmer is required to file an affidavit with the local registrar before Burial-Removal-Transit Permit is issued.
w The Burial-Removal-Transit Permit must be delivered by the undertaker to the sexton or other person in charge of the cemetery where burial takes
(r 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
th there is no sexton in charge of cemetery, the undertaker or person acting as such shall sign the l'ermit as sexton,write across the face of Permit the
7 words,"No person in c arge"and return ermit to local registrar.
o Body was ._.� � on IW , 19 Sal°, •in
(STATE W E E DRIED, 'tTGT)
*dir--04-2-04-- Cemetery •i - _ City-- '/ State.
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(Signature) .Qr" -� ''
fr 4 (SEXTON OR PER I. A E
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m if Body is to be Shipped, fill out the spaces bel$w:
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a Shipping Station , Florida, for . Name of Cemetery
O Q2,1440
1ST ATE WHETHER BURIAL ORaa CREMATION)
J (if obtainable) at i.2tri State _ �[_lef lJ'Ld
a Consigned to -- - Address__- f i - 28/N/-----day ..--
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� I hereby certify that I permitted the shipment of the above named a edof •D�4G�,lr�_ �D-, 19
1- re)
~ _ (TICKET AGENT OR BAG EMAN OR EXPRESS AGENT)
Z Name of Transportation Company• ____
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Rules of the State Board of Health of Florida Governing the Transportation of Dead Bodies
TRANSPORTATION AND DISINTERMENT OF DEAD BODIES wooden box or metal vault;provided,that the body will reach its destination within eighteen
(18) hours'from time of death.If the body cannot reach its destination within eighteen (18)
Rule 1. A Burial-Removal-Transit Permit issued by the Local Registrar,his deputy or sub- hours from the time of death,then the body must be prepared as provided by sections (a)
registrar of the registration district in which the death occurred,or the body was found,must and (b) of Rule 2.The outside case may be omitted in all instances when the coffin or casket
accompany each dead body when transported. is transported in hearse, funeral director's s chicle, private vehicle, private railroad car, or
(a) The Burial-Removal-Transit Permit must state the place of death,name of deceased, private airplane.A body to be transported by any common carrier must in all instances be en-
sex,color or race,age,and the date of death,the date of shipment,the point of ship- cased in a sound coffin or casket and enclosed in a strong outside wooden box or metal vault.
ment and destination,and shall bear the signature and title of the Local Registrar who Rule 4. In the shipment of bodies dead from any of the diseases named in Rule 2,such
issued the Burial-Removal-Transit Permit. bodies shall not be accompanied 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, unless 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. Rule 5. No dead body shall be disinterred for transportation without the written consent of
Rule 2. The bodies of those who died of smallpox,bubonic plague,Asiatic cholera,scarlet the State Health Officer.All disinterred remains shall he encased in an airtight iron,steel,zinc,
fever (scarlet rash,scarletina), glanders, anthrax,leprosy,epidemic meningitis,poliomyelitis copper or lead lined coffin or casket, all joints and seams hermetically sealed or sealed by
(infantile paralysis),or measles,shall not be accepted for transportation unless prepared in the gasket and all encased in a strong 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 lining.
(a) Arterial and cavity injection with afi approved disinfecting fluid.
Rule 6. When dead bodies are to he shipped by express,all of the preceding rules shall
akrtd stupgitr of all or• ces with absorbent cotton...T, apply except the BuriabRemovabTransitPe_rmit shall bg�f[ache�Ee aUd.arcns�i'i. `.W ILtl. _ _
(c) k a umg the hod y w uh drsmf c ._......__.-.,.-..-__,�,,, _ a .-—r,�,,,.. ._ ,.
•$S Rule i. Bodies deposited vaults,public or private,shall be prepared in accordance with
(d) The body,after being prepared in the above manner,shall he=,encased in an airtight section (d) of Rule 2.
iron,steel,zinc,copper or lead lined coffin or casket,all joints nd seams hermetically
sealed or sealed by gasket and all encased in a strong met or wooden box; or Rule 8. When it boTy Mg been held fifteen(15)days from date of death,permission of the
the body placed in a strong coffin or casket and encased 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 twenty-eight'(28) gauge,metal lining. Rule 9. The depths of all graves is the State of Florida must be at least four and one-half
Rule 3. The bodies dead from any cause not specified in Rule 2 shall be accepted fo- feet deep with the exception that where it is impossible to do so,body may be buried in a
transportation only when encased in a sound coffin or casket and enclosed in a strong outside manner which is satisfactory to local and state health authorities.
'INSTRUCTIONS TO LOCAL REGISTRARS If the body is shipped by express,the Burial-Removal-Transit Permit must be attached to the'
Waybill,and the receiving agent shall turn it over to the receiving embalmer,undertaker,or
Local Registr s must keep a sufcienL cumber of Burial-Removal Transit Permits on hand - person taking charge of the remain,'for final disposition.
and order additional supplies when needed from the Bureau of Vital Statistics,Jacksonville.
Burial-Removal-Transit Permits are not to be distributed in blank among'embifiners,funeral Every outside case holding a dead-body offered for transportation shall bear at least four
directors or any other persons,but are to be kept by the local 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-Removal•Tramit Permit which must be two on each side and one on each end with approved bolts and lock nuts.
signed by the funeral director who prepared the body for shipment.
Under no circumstance.shall an agent or baggagemaster receive a body for transportation
INSTRUCTIONS TO TRANSPORTATION AGENT OR IIAGGAGEMASTER when fluid or offensive odors are escaping from the case.
The Burial-Removal-Transit Permit should be placed in a stout-nvelope and attached to _ The coupon at bottom of Burial-Rcns,val-Transit Permit should be filled out by transporta-
the outer box or case and at destination turned over to the undertaker or person having charms _ tion agent or baggagemaster at shipping station and mailed to State Board of Health,Jack9onr
of the burial of the body. - vine,Florida,within twenty-four(24) hours after shipment of body.
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