Brown, Willard +� PERMIT
M 5 —V. S. 15-3-30. TRANSIT PERMIT
STATE OF OHIO
STATE DEPARTMENT OF HEALTH
COLUMBUS
.x "A. Transit Permit issued by the Local Registrar of Vital Statistics must accompany each dead body
•5 transported by a common carrier.—(Section 215, General Code).
...Ni UNDERTAKER'S CERTIFICATE
'II I Hereby Certify that the accompanying dead body of !!v /_!L L�R W• 13 R ¢ 141 N
u
Y.-..__-.__.. _____ _---_--who died in the__c-!1_.Y_-_-_ 0 f of e L 4- U eiL A N _•-----
GS (City, VillageAt Township)
bCounty of C Li.y_ili-PI O &A __, State of Ohio, on (,--_ 4r__!4.f _..__. . ...,E_ 1.9.S.L51 Sex__
Color or r ce , W 1� 1._._T_.F. -__ Age-_/_._._L.$.._..__9.._.._.yea._—.___.___ 111onths days, and Cause of
• Death- . _ - _ " .���e^ j'�_4te t,-.....,r? .Q.et_Gr has been prepared for transportation
>; strictly in accordance with REGULATIONS OAas printed with this blank by /H. _19t8 :QccNlicensed in the State of Ohio,
r (State Number of Regulatio (Name of ,mbalrner)
• T 32 il.g
�• License I`u._..-._.. ._ Date of shipment A��nn 6S T+ 19s�:�. �7 p
:M Route of shipment AC ___� YO l ` E//,[_._it A L J7-:.l-A.-
4.1 LAN� 0AOt - S fA
Point of shipment �- k V� �. Q , Point destinatior ___f�... .4..S._„t_.A6._._):"...__.
(Signature of Shipping/ Funeral Director) r '
Dated-•__A. .G.� .,--3 4. ., 191 7._ - Address !s��'1 e .. 'a A Y e• c,4 cVl,
PERMIT OF LOCAL REGISTRAR 9,
t
• Dist. No., Registered No
Date of issuance =:'•_ ' _--19___.--•
A satisfactory Certificate of Death for above decedent having been filed and recorded in my office. PERMISSION IS HEREBY
GRANTED FOR THE REMOVAL AND SHIPMENT OF THE BODY.
• tune of Local -str
Local Registrar of the - of....__ ___..... , County _-_ __ __.
(Cit, V' age or ship) ,
State of Ohio.
se—Only the Local Regis r (Deputy or Subregistrar) can issue a Burial, Removal Trans' Permit.
Detach here and give part above to escort or attach to waybill if shipped by express
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE OF PREMISES ON
WHICH INTERMENTS OR CREMATIONS ARE MADE
Date of was.
(I a ment or cremation)
(Signed)
Person in charge of �`'"—` "—Y—
(Name of Cemetery, Crematoyfnm etc.)
Person in charge of premises must return this Permit to Registra° his District within TEN (10) DAYS from above date.
If no person is in charge, the UNDERTAKER MUST SIGN ABOVE STATEMENT, write across the face of the Permit the
words "No person in charge," and FILE PERMIT WITHIN THREE (3) DAYS with Registrar of District in which cemetery
is located.
EXTRACTS FROM LAWS OF OHIO
GENERAL CODE SECTIONS.
CERTIFICATE OF DEATH SHALL BE FILED WITH LOCAL REGISTRAR TO OBTAIN BURIAL PERMIT. SrxrioN 214.
Prior to any disposition of the body, the undertaker, or person acting as undertaker, shall obtain and file a certificate of death with the
local registrar of the district in which the death occurred, and secure a burial or removal permit. He shall obtain the personal and sta-
tistical particulars required from the person best qualified to supply them and the signature thereto and address of his informant. He
shall present the certificate to the attending physician, if any, or to the health officer or coroner, as directed by the local registrar, for the
medical certificate of the cause of death, and other particulars necessary to complete the record, as specified in the preceding two sections.
He shall state the facts required relative to the date and place of burial, sign his name thereto with his address, and present the completed
certificate to the local registrar, who shall then issue a permit for burial, removal, or other disposition of the body.
BURIAL PERMIT SHALL BE DELIVERED TO CUSTODIAN OF BURIAL PLACE. SECTION 215. The undertaker shall deliver
the burial permit to the sexton, or other person in charge of the place of burial, before interring or otherwise disposing of the body; or
shall attach the transit permit, containing the registrar's removal permit, to the box containing the corpse, when it is to be shipped by a
transportation company, which permit shall accompany the corpse to its destination, and, if within the state of Ohio, it shall be delivered
to the sextion or other person in charge of the place of burial.
CONTENTS OF PERMIT 1F BURIAL IN STATE. Skc1Iox 216. If the interment, or other disposition of the body, is to be made
within the state, the burial permit may contain only a statement signed by the registrar that a satisfactory certificate of death has been
filed with him, as required by law, and that permission is granted to inter, remove, or otherwise dispose of the deceased, and stating the
name, age, sex, cause of death, and other necessary details upon the form prescribed by the state registrar.
CUSTODIAN OF BURIAL PLACE SHALL ALLOW NO BURIAL WITHOUT PERMIT. StcrioN 217. No sexton or person
in charge of any premises in which interments are made shall inter, or permit the interment or other disposition of a body, unless it is
accompanied by a burial, removal or transit permit, as herein provided. Each sexton, or person in charge of a burial ground, shall indorse
upon the permit the date of interment and sign his name thereto. All permits so indorsed shall be returned to the local registrar of the
district within ten days from the date of interment, or within the time fixed by the local board of health. He shall keep a record of all
interments made in the premises under his charge, stating the name of the deceased person, place of death, date of burial, and name and
address of the undertaker. Such record shall at all times be open to public inspection.
PENALTIES.
BURIAL WITHOU'T PERMIT. SECTION 12685. Whoever, being an undertaker, sexton, or person acting as undertaker, inters, re-
moves, or otherwise disposes of the body of a deceased person without hang received a burial or removal permit as provided by law,