Bullard, Etta 11.E.VS rittour-onine.
Burial Permit No. .. ‘f
O ,t•e - BURIAL—TRANSIT PERMIT city or-,
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cri
41 Full name of deceased
O Place of death -1)...eZ 4••••• 4/P..etw• •• ..iCeirrel 1 2/
E. (Town City) (County) (State)
Cr1 Date of death S..../--2.. -.• 19.c...1.73. Color )47 ' Sex V---.- ....._...Ne ..F.',..5
• e t h o d of dis s .... .. .. . .. .../.449441...-.1...i.- •
( e urial, remation, transportation, storage, etc.) etery o r matory)
0.1 Town or City . .. ... . County State 5.ifirt.LAr—
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:,--. tificate dea i4 yin n fi as required by the lay% of this Sat!, permissi is hereb given
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.,,4 to . . . r-, . . .. . . . • Address i.-Vcrlr.a7 / 'n • 9,i
... (Fuller. I irector)
to ispose of hod of deceased as o stated.
8 Dated at 0-Nrt,r7..v.Ai this. . cl 19. 13
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C..) (Address)
<4 Signature (../.
(Town C k, ub-Re istr , t ity Board of Health)
i-. CEMETERY Oi)211ttliktk)RY AUTHORITY S ILL OUT BELO "'-
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2 Body was1-Z z"--41- 'con *1 9 19-'‘)7J in
e whethec gremated, buried, starfd, etc.)
...,1"" Place..,,e'r*f-t-e•-e-v.:0 ....4,-.4, tery or Crematory)
-... 2..t. .7. .4.. Section C7
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1:4 Lot No. 7 ....k Grave No. 1,°. Signature 7r2-16%41-/1"-‘s --IVO
V.1 (Sexton or person in charge)
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This permit after being signed by the Sexton or person in charge (or by the Funeral Director where there is
no Sexton) must be forwarded within six days to the Clerk of the town in which the burial takes place.
26635 Form BT-1 7-51-20M eaft-IL.C.- aelel , SEE OTHER SIDE
READ CAREFULLY
OFFICIALS: This burial-transit permit may be issued only upon receipt of a death certificate—Not Before—,
or in exchange for a burial permit issued at some other place. In special emergencies,telephone the office of the
State Department of Health, at the expense of the applicant, for instructions.
FUNERAL DIRECTORS: The burial-transit permit is required for any manner of disposition of a dead
body including interment, storage, cremation, and transportation. A permit is required for each still-birth, be-
fore disposal of the body.
When used as a transit permit for transportation by common carrier, this permit or a duplicate thereof
should be enclosed in a strong envelope attached to the shipping case. No separate transit permit is required.
Before shipment by train or express, the body must be embalmed; or if that is not practical, must be
enclosed in a tightly sealed casket or outer case.
This form is not to be used as a permit for for disinterment.
SEXTON: It is unlawful for any sexton, or other person having charge of a burial place, to permit burial
or other disposition of a dead body before a permit is deposited with him.
All permits must be preserved, and forwarded within six days to the clerk of the town of burial.
PENALTY for violation is from $10 to $50, or imprisonment from ten to sixty days.
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