Abbott Jr., Alson Order by Number "g
Form 5-VS.
(Always write with black ink) TRANSPORTATION OF CORPSE
1 PLACE OF DEATH STATE DEPARTMENT OF HEALTH—BUREAU OF VITAL STATISTICS
County ll21ion. State SLEW JERSEY Registered No.
Township or Borough
City PZainf eld .... No. 1209...D0 . -&NISI--------- St., Ward
(If death Wired in a hospital or institution,give..its NAME instead of street and number)
C 2 FULL NAME AA1 I. _Il .ag-an_ tt.�=d. a
_ 3 Residence. No.___�.2z9�@n ...(L-r St.,. Ward. .
,, '^' - �- -- tom-
Le(Usual place of abode; is institutions homes, etc former residence SliZit-'be stated.) (If non-resident give city, town and State.)
O N Length of residence in .er town where death o ll'uta d yrs. mos. days.-How long in U.S.,if of foreign birt yrs. mos. days
PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH
gal 4 SEX 5 COLOR OR RACE 6 Sinai°,11Zarrlod.Widow er 17 DATE OF DEATH
E." Q Divorced (write the wore) JuleT � �J t 19-
U li, F• white • Bungle ? 18 I HEREBY,CERTIFY, That I attended deceased from
Q 7 If married, widowed or divorced ---_jJSi21e-- 4th--_ i to_-_-.�.], 19_
HUSBAND OF
.�- �
W kI (or) WIFE OF I Jest saw h=alive on__il1 y._.6th.y 19____, death is said
4 V (Give full maiden name) to,have occurred on the date stated above, at___.2.._Q_A.•.m.
..l 8 DATE OF BIRTH The principal• cause of death and related causes of Date of
.d (month,day and year) • Apri�. 12, '1,C 06 -
I!!A" 9 AGE Years Months Days It Less . imptiftance in,.a{der Of,Alit5t were as follows: onset
g-t 25 2 1 24 Than
Aeutta__Catarrh l_apaendic : . _s 3. 3i
°C 0 Trade, profession, or particular
U 1 Z , kind of work done, as spinner,
.2 sawyer, bookkeeper, etc. 1 -= - ,- -
1 ""� Industry or business in which S ten da �
gB+ a, work was done, as silk'tale
W D saw mill, bank, etc De t. r Contributo
O Date deceased last worked at Total time (years) ry causes of importance not related to
this occupation (month and spent in this principal cause: ,,,1� G
V -" year) occupatim Thal it'n TW___¢J bg2.1. 6422 31
.-.rti, 11. BIRTHPLACE(city or town)__ 12t'a-iaal 1 � -�c£Ix'S31I- N 7r• 7i/�,
4 " (State or Canrttry) Name of operation=.._A.P ff� 'it A-Date of__t2 _ .7231
g 1,4 ''I2. NAME Abbott
test confirmed diagnosis?_31013d_-eJLaIII na..t�Q21._
ZO , Anson M.
13. BIRTHPLACE
"' , Was there an autopsy?—yA.*-
a wHPLACE (city or town) N.Y. __ __ _ FOR COUNTY PHYSICIANS AND`CORONERS
(State or Country) (violence) fill in also the
z �" If death was due to external causes
V w 14. MAIDEN NAME ma
��p ' following Date of
ri F.1 F ma A. Earle riO .,.n Accident,. suicide, or homicide? injury 19_
'Q I 0 13a. BIRTHPLACE (city or town)____.N..I. Where did injury occur?
Q (State or Country) (Specify city or town,county,and State)
15 /� Specify whether injury occurred in industry, in home, or in
Q INFORMANT _ .
44 (Address)/ q - public place
Z r Manner of injury
View'Cemeter
gal w Fttf firifi its, •$ / 4 injury Nature � in ur 4
.�. Cremation or Removal • Date_7/_��31. 19_ __ Wa disease or injury in any way related to occupation of
1'4 - � . .„N
21. UNDERTAj�ER _ �i , a, --- ------
(Address) d 0 -- - l A' ,f s` , fy
,O . (Sl ) ""_ 5_0- ran; , m. D.
CEIVED b ' )_ _ . '
�. . Lo...' - ,{Address J.•
.' . INT OF BOARD OF
- --- TI;I OR REGISTRAR
This Permit with above Certificate must be presented t---"IrWlittliaggage Agent and delivered with bo at destination.'
iltlx_-LI,___1Q31 19 �..._
Permission is hereby granted to remove for burial at �' #@__y�@�__�t�'rtll. Glens al] _ -� the bads
of SO ._1.-_AbbO-tti___Jr.. above described, if prepared in accordance with the laws o thiy ate;
printed on the back of this permit. •
!_ ....Y , el _JiJ—_1Me� AS� _
- -- - Healtlt'Offi`cer..or 1 egistran
aTF?ttarh show, nn is verforarsna.and hand to oars er in eharsu� lioa..,i .., A.. .,.:aay..,1,a.. ft. ..a.:...s d.,r. -
F \ ,, . ,,, 4
Rules regulating the transportation of dead human bodies iasuod by the Department of Health of the State of New Jersey.
1. The transportation of bodies dead of small-pox, Asiatk.cholera, yellow fever, typhus fever and bubonic plague is forbidden
except a license therefor is first obtained from the State Department of-Health or from an inspector or officer of said department,
and no license for the transportation of bodies dead of said diseaases will be issued until it is shown that said bodies have been
prepared in accordance with the written requirements which shall-in each case be specified and made a part of said license.
When the dead body is net--to-remain unburied Ignorer than seventy-two hours--
2. The bodies of human beings dead of any cause whatsoever other than the diseases in rule number one shall not be trans-
ported by any common carrier unless said bodies shall first have been treated as follows:
(a) Remove all garments from the dead body and apply to the surface a solution of bichloride of mercury prepared as fol-
lows: One part each of bichloride of mercury and muriate of ammonia to 1,000 parts of water.
(b) Fill all openings with cotton wool which has first been saturated with the merquriai solution anti allowed to dry. The
cotton used should be dry and be firmly packed.
(c) The body should be placed in a coffin or casket, and should rest upon a layer of sawdust or other absorbent material not
less than two inches in thickness. After the body has been placed in the coffin, the coffin should be securely closed.
• (d)"The coffin or casket containing the dead body should be placed in an outer box, strongly made of seven-eighths boards.
When the dead body is to remain unburied longer than.i iventy-two hours, and in all cases of diphtheria, membranous._
1- croup, scarlet fever, chicken-poz, measles and erysipelas--
3. After being prepared as required by rule 2, the dead body, contained in the coffin or casket, should be placed in a sub-
stantial metal-lined box, and said metal-lining should be mgde air-tight by soldering all the joints and seams.*
4. In case of dangerous communicable diseases the body Should not be accompanied by persons or articles which have been
exposed to the infection of the disease unless a certificate has been issued by the local board of health, or its authorized officer,
showing that said persons or articles have been rendered free from infection.
5. Every dead body transported out of the State must be accompanied.by a transit permit showing name of deceased, date
of death, age, place of death, cause of death and the point to othieh the body has been transported, and also-the name of the person
authorized to accompany the body, if any person is so authorid. The transit permit shall be securely attached to the outside
-- .of the_cnfn-hn'r and shall not be mutilated iti the process of bein attached.
6. No disintd body shall be offered for transportation`to an common carrier unless the disinterment has been authorized
in writing by the local board of health, nor unless written consent for such transportation shall have been obtained from the
health authorities of the locality to which the said disinterred body is to be consigned. All 4isinte;red bodies shall be enclosed in
an air-tight metal-lined box and all joints and seams in said metal-lining shall be soldered. Bodies placed in receiving vaults
shall be treated in the same manner as bodies buried.
7. Dead human bodies which are prepared in New Jerseyfor transportation within or across the State by common carrier,
and which are offered for shipment at some point within the S ,_shall not be treated with injections of arsenical or other poison-
ous solutions, and no such solution shall be introduced into the lood vessels or cavities or beneath the surface of the skin of any
such dead body.
8. Permits for disinterment of dead human bodies shall be id after seventy-two hours have elapsed from date of issue.
9. In procuring transit permits for disinterred dead.,human bodies the undertaker shall swear or affirm that the remains have
been prepared in accordance with the rules of the State } a ._"nt of Health.
These Permits or Burial or Removal Permits are not to :a used as authority for the removal of disinterred bodies from
one district to another either within or without the State. A s 'cial-form`entitled "Transit Permit for Disinterred Body" should
be secured from the local registrar or the State Department of ealth, Trenton, N. J.
*The preparation of dead human bodies for transportation by ' c carriers as provided for in these rules does not preclude the em-
ployment: of additional precaution against the decomposition of the ns.
''_
. .
4.
.
///lji
t
I
.-
A, s.
w
S
m
�_. SL