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Smith, Clarence BURIAL - REMOVAL -TRANSIT PERMIT Place of Death: '' ' FFLORIDA STATE BOARD OF HEALTH 1 County BUREAU OF VITAL STATISTICS W a• Precinct 143 Z City or Town----------- ----- - 4�— 'J'utJ,..-.- _ UMBER MIT UM OF PER F Name of Deceas .._AgeL�-ZSex Color_ --// - -- - --- - - - - - -- ---- Ze..) Date of Death_3_//(2 ,19 N me of Cemetery or Crematorium - Removal to: City State `Ec I hereby certify that I have prepared for burial or other disposition, the body of the above na ed deceased strictly in k,a accordance with the laws of the State of Florida and the Rules and Regulations of th ate Board of Health of Florida .,ii governing the disposition of de d human bo 'es. .W• Firm Nano 4--74. J (Signature)._ _ ce e No. ( UNERAL DIRECTOR) / 4 A death certificate having been filed in my office, permission is hereby granted for the burial, transport tion, cremation or esplacing in vault (cross out words that do not apply) of the body the above named eceased. (Signature Local Registrar If the holy is embalmed,the licensed embalmer is required to file an affidavit with the loc • emoval-Tray git PermiLisiasued. ,_ �W The Burial-Removal-Transit Permit must be delivered by the undertaker to the sexton or other erson in cha of the cemetery where burial takes .re place.This Permit must be endorsed by the sexton and delivered within ten days to the local registrar of the istrict 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 Permit as sexton,write across the face of Permit the • words,"No person in charge" r return Permi to local registrar. o B was o Z'� , 194 in (STATE wETHER BURIED, CREMATED O ACED IN EIVI G VAULT) a ,il.-v,,L ( .rS,L�saF—$ Cemetery • Cit State. W .,. ...44......_"6„.......„ (Signature a (SEXTON OR PERSON IN CHARGE) Q a 5 If Body is to be Ship ed, fill out the spaces below: W ' r Shipping Station , Florida, for . Name o Cemete (STAY ETH R BURIAL OR CRE ATION) .-I• (if obtainable -State W i. Consigned to Address z I hereby certify that I permitted the shipment of the above named eas-'' this_._ ..._,_.day of..... _. __ , 19 J O 9, Ili �Signat e _ _ `# =_ O (TICKET AGENT OR GEMAN OR EXPRESS AGENT) Z Name of Transportation Company ,,, - 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 I. 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 vehicle, 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 be 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 an approved disinfecting fluid. Rule 6. When dead bodieas are tobe shipped by express,all of the nreredjn&.ru7«c.101 _ _Di§y�fectiott_a .^_4-nf xil-n ti"t u --`a`ppTy eiceptihe Burial•ll.emoval•Transit'Permit shall be attached to and accompany the Waybill- (e Was mg e ody with disinfectant. - Rule 7. Bodies deposited in vaults,public or private,shall be prepared in accordance with (d) The body,after being prepared in the above manner,shall be encased in an airtight section(d)of Rule 2. - iron,steel,zinc,copper or lead lined coffin or casket,all joints and seams hermetically sealed or sealed by gasket and all encased in a strong metal or wooden box; or Rule 8. When a body has 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 in 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 for 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 expresarthe Burial-Removal-Transit Permit must be attached to the Waybill,and the receivingagent shall turn it over to the receiving embalmer,undertaker,or Local Registrars must keep a sufficient number of Burial-Removal-Transit Permits on hand person taking charge of the remains 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 embalmers,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-Transit 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 circumstances shall an 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 in a stout envelope and attached to The coupon at bottom of Burial-Removal-Transit Permit should be filled out by transporta- the outer box or case and at destination turned over to the undertaker or person having charge tion agent or baggagemaster at shipping station and mailed to State Board of Health,Jackson• of the burial of the body. ville,Florida,within twenty-four(24)hours after shipment of body.