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Homer, Madanne BURIAL - REMOVAL -TRANSIT PERMIT Place of Death: ...--, _ I 1- FLORIDA STATE BOARD OF HEALTH 2 County ,O.A.12..... 1..0._- BUREAU OF VITAL STATISTICS mw 0- Precinct I- ......-A- i City or Town GCLA....4e,, . NUMBER OF PERMIT 13 6 re• Name of Deceased..2kLata.4..evut—,_ j -21.-7,1,2A, A......yr7:40SieZ Color___ld___ Date of Death friadit 6 ,19_44. Name of Cemetery-er-GPenteterittm_eW 'titig '/./. o Removal z it to: City gcatg- -714) yIVI-k,....4„........,..r.. State w rei I hereby certify that I have prepared for burial or ther 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 Health of Florida Ee the dis osifion of dead human bodies.governing - t m • etWaric. • Firm Na ! _ _ _ ___ _ _ _ _ (Signature __. . _ . _ _ . icense No. t.,3 4,-/ D (FUNERAL DIRECTOR) ID • A death certificate having been filed in my office, permission is hereby granted for the burial,transportation, cremation or a• placing in vault (cross out words that do not apply) of the body of the above named deceased. A274;c1,..0 re (Signature),„& _. .244•--Local Registrar < * = I- 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. to iThe Burial-Removal-Transit Permit must be delivered by the undertaker to the sexton or other person in charge of the cemetery where burial takes it 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 ii 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 7 words,"No persojj.jn charge"and return Permit to local registrar. u) ix Body was_ .,Ice..e..e.41 ..4,„_. ' 2/04-44.47! on ,,,2,7 , 19 4:7 in o (STATE WHETHER BURIED, CREMATED 0 ACED IN RECEIVING VAULT) )- V, Cemetery ___ _ _ ___1 -e_00 City State. w 0 — (Signature)k.. 74,....4-444, ....." r, (SEXTON OR PERSON IN CHARGE) at a t - 5 If Body iS to be Ship,ed, fill out the-spaces below: w i rx ..1 Shipping Station /40, .,// ii • -,Florida,for Aidateee . Name of Cemetery 6 A I /' ..„Litifiggiefir r, / / . TE WHETHER BURIAL OR 94MATI ) U 0 -I (if obtainable) 041- __ at A.. .!_' _ ...- IT.aitei tat w e drb ' • T. Consigned to Al° Aleitiste4 . ki I hereby certify . . permitted the shipment of the above named deceased this day of , 19 (Signature)/12?4,400(44.,t fre-' ' '11/ )1( I- 0 . AZOLET AGENT OR BAGGAGEMAN OR EXPRESS AGENT) 2 Name of Transportation Company_ -•_ A. • 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;pros ided,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 front the time of death,then the body must lie prepared as provided by sections (a) registrar of the registration district in which the death occurred,or the body was found,mutt and (h)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 oust in all instances lie 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 racket 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 oodies dead from any of the diseases named in Rule 2,such issued the Burial-Remova4Transit 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 the State Health Officer.All disinterred remains shall he encased in an airtight iron,steel,zinc, Rule 2. The bodies of those who died of smallpox,bubonic plague,Asiatic cholera, glanders,anthrax, or epidemic meningitis shall not be accepted for transportation unless pre- copper or lead lined coffin or casket,all joints and seams hermetically sealed or sealed by pared in the following manner: gasket and all encased in a strung metal or wooden box; or the body placed in a strong coffin 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, (al Arterial and cavity injection with an approved disinfecting fluid. Rule 6. When dead bodies are to be shipped by express,all of the preceding rules shall Ilit Disinfection and stopping of all orifices with absorbent cotton. apply except the Burial-Removal.Transit Permit shall he attached to and accompany the Waybill. ) Washing the body with disinfectant.-, Rule 7. Bodies deposited in vaults,public or private,shall be prepared in accordance with (dl 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 A.nswl-.or-.wooden box; or -. .Rule8. When*bodxhas 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 m-st be obtained before the body is offered for transportation. outer_wooclen box lined with not less than twentyeight (28) gauge metal lining. ------- -- - -Rule 3. The bodies dead front any cause not specified in Rule 2 shall lie accepted fur transportation only when encased in a sound coffin or casket and enclosed in a strong outside INSTRUCTIONS TO LOCAL REGISTRARS If the body is shipped by express,the Burial•Removsl-Transit Permit must be attached to the Waybill,and the receiving agent 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 sear 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 inn stout_envelope and_attached to The coupon at bottom nf._Ruriad•Aemoval-Teansi�P.swc�Isouldjse filled-oe�b;-uaeaperta-- . ....- aoe aeottn.aon 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 twentyfour(24) hours after shipment of body.