Zimmerman, Blanche ,„.. OHIO DEPARTMENT OF HEALTH Permit No, .4„Pr. $5 70
VITAL STATISTICS DIVISION
i:..., COLUMBUS BURIAL--TRANSIT PERMIT
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E-1 Full name of deceased ,L---7c-ce_ 57
coD
61.1 . ..
a Place of death ORA.:17:0
O (Town.) (Village) (City) (County) (State)
E.4 Date of death .. /ii , 19 5) CAlor (••,) Sex 4 Age 6
4 Cause, of death
ex.L.c_r.„.......
"ell Method of disposal
(Whether interment, cremation, or other disposition) (Na
l le of ceme ry or rematory)
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- County State .7.24,4/
A satisfactory certificate of death having been filed as required by th8laws f thi Sta e,permission to dispose
-t/
ts.1
• of body of said deceased as above stated, is hereby given to Tr;a -
O (Funeral Director)
U Address i..Y q 4 -1/i 90141-€L „a
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-4 Registration District No 770 ( at 0-1)24-4"1,- Date 14 19 5-3-
con Signat - . , _.., ke,-z„.
(Na of Registrar)
CEMET-EBY OR CREMATORY AUTHORITY SHALL FILL 0 P.O._.F BEe:7"
• Body was 2:22- -1....-3:11.ems.,::d on.6 .kc •.......i 7 , , .1'3 in. ,,,-•;-'•-•-e ‘-cm•-•-•
.1-y i
c4 (State wheth interred, creassatedr-oz-ather... disposition) i ( ' in, of cemeter or cremai,e7)
411T4, Plac ... 77.;; i-C, --22y Signature
.,, (Sexton of cemetery or crematory) '
Con
= This permit must be endorsed by the sexton, or person in charge, and shall be returned to the local registrar
E-I issuing the same, within ten days from the day of interment, or other disposal. vs-14
READ CAREFULLY
REGISTRAR: This burial-transit permit may be issued only upon receipt of a satisfactory death certificate;
not before.
FUNERAL DIRECTORS: The burial-transit permit is required for any manner of disposition of a dead body
including interment, cremation, and transportation. A permit is required for each stillbirth, before disposal of the
body.
When used as a transit permit for transportation by common carrier, this permit shall 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; and enclosed in a proper casket and
outer case.
Where death has occurred from a communicable disease, the body shall not be removed until written permis-
sion has been secured from the health commissioner of the health district in which the death occurred. In cases
where death has resulted from violence or external cause, the body shall not be removed without the consent of
the coroner.
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-transmit permit is deposited with him. (The local Registrar may accept
the permit of any state, of the District of Columbia, Canadian Provinces or Mexican States, as authorization for
burial.)
All permits must be endorsed, recorded in the sexton's register, and forwarded within ten days to the registrar
of the district in which the burial-transit permit was issued.
44'S