Smith, Robert 8 cc BURIAL—TRANSIT PERMIT 15214
MICHIGAN DEPARTMENT OF PUBLIC HEALTH
Full name of deceased Robert L Smith No.
Cause of death Gunshot wound to the head
Place of death Wayne Detroit
(County) (Township or village or city)
Date of death 1 November 19 70 . Race White Sex dale Age 46
Method of disposal Removal — Bu ri al nrte_r14,@WI Cemetery
(Whether burial,cremation,storage,etc.) (Cemetery or crematory)
' County— V+ ren state ..Re14,-Xcrk
A certificate of death or fetal death having been filed as required by the laws or regulations of this state,permission is
hereby given tin & GR Harris Funeral Rome Address Detr t/Michigan
(Funeral director or person acting al such)- j
1 to dispose of body of said deceased. L///
Signature— �� 2 • Q D e — 19
(Check one: 0 Regis r, Funeral Director, Mortuary Science Licensee)
METERY 4R EMATORY AUT ORITY SHALL FILL OUT--SPACE B L
Body was et `'e/(J —e o l/ e9 19 i \'�ZC --e-eGG)"-
( tate whethe�emate,buried,s ored,etc. (Cemet .Csew
I Place/e7I171 r J '7�-t-v�-e�✓ .�-[ Sign e 'v '�° /' �.'lit
(Sexton or person in charge)
1 This permit must 'endorsed by the sexton (or byjhe f` neral director o Mortuary Science licensee wher ere is no
sexton) and returned within seven days to the restra� the district i which the burial takes place.
' (OVER)
READ CAREFULLY
REGISTRAR: This burial-transit permit may be issued only upon receipt of a completed death
or fetal death certificate. Burial permits when endorsed and returned by sexton, funeral director,
or mortuary science licensee, will be filed with the registrar of the district in which the burial
takes place.
FUNERAL DIRECTOR OR MORTUARY SCIENCE LICENSEE: The burial-transit permit
is required for transportation and any manner of disposition of a dead body including interment,
storage and cremation. A permit is required for each fetal death,before disposal of the body.
Under no circumstances shall a funeral director or mortuary science licensee issue a burial-
transit permit to anyone other than himself, and then only according to the provisions of Act 198,
P.A. 1966, and Rule 4, "Governing the Transportation and Disposition of Dead Bodies."
When the body is to be transported by common carrier, the burial-transit permit shall be is-
sued in duplicate. The original shall be attached to the shipping case in a strong envelope. As a
safeguard against loss in transit, the duplicate, so labelled, shall be mailed to the funeral director
at destination, or handed to him by the escort traveling with the body.
SEXTON: It is unlawful for any sexton, or other person in charge of a burial place, to permit
burial or other disposition of a dead body before a burial-transit permit is deposited with him. (The
sexton may accept the permit of any state and of the District of Columbia, as authorization for
burial).
All permits must be endorsed, recorded in the sexton's register, and forwarded by the sexton
within seven days to the registrar for your district.
If the body is buried in a cemetery having no sexton in charge, the funeral director or mortu-
ary science licensee shall sign the burial-transit permit and file it within three days with the regis-
trar of the district in which the cemetery is located.
B-26—Rev 8/66-75M