DeLisle, Joe County Obion STATE OF TENNESSEE
Permit No.
1 ut h STATE BOARD OF HEALTH
Civil Dist Reg. Dist.No
Inc.Town
Bureau of Vital Statistics
City _ ity, "�enr. , BURIAL OR REMOVAL PERMIT
Full name Joe DeLisle Age Sex ale Color 'Mite
Disease causing death Lobar Pneumonia Date of dreth clay 4-l:.i<:9•
Place of burial............... .
OR
Removal to Tlen Falls' T Y. vial ess.
Undertaker White .Pros T7nson, Address '.� Te 71
•
A certificate of death_ having been filed in my office in accordance with t a} s of Tennessee, 1 hereby
authorize the - :%7"— of the body of said dece d .,, was sated above.
(BURIAL OR REMOVAL)
Dated -,J - r 19 Registrar's Name .. . .__.
Burial permits must be delivered by the undertaker to the sexton or other persons arge of t°ke burial ground or cemetery where burial takes place
When the body is to be shipped to a distant point,requiring the service of a common carrier,in addition to the removal permit,the body must be accompanied
with a transit permit as required by the State Board of Health. For full particulars see Rules and Regulations Governing Transportation of Dead Bodies.
Sexton's Signature 2�- e4.ft.. _ Ul�Date of interment t , c 19 Z.1
This permit must be indorsed by the sexton and returned to the Local Registrar of his district within ten days. If there is no sexton or person in charge
of burial ground, the undertaker or person acting as such shall sign same as sexton,giving date of interment. Write across face of permit the words No
sexton in charge."and return to the Local Registrar of the district within ten days.
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