Rhodes, Charles FLORIDA STATE BOARD OF HEALTH
i Burial Permit No.v? 7 3 5 I-
kJ ,tIA -TAN IT I3)/11_v,III,'
, -----,
Full name of deceasrp L 4
! Place of death fr.-<._. Florida
(CityL, _ (Coubty,
: Date of death
19.:6 .?, Color t.-L).--ti v x ,--2-72 , Age 20
i ,. ..
: Method of disposal ---"t---e -714---11---"6-t---A--21
(Whether burial, cremation, transportation, storage, etc (Ce te or Crematory)
(km n ty, (..-17--/,--.^(_--T State
I Ai crtific_atee of death r* been fSed as required by the laws_of this State, permission is hereby given
to i j -- --:t License No
I ( uneral Director r person acting as such)
to dispose of body of s 'd deceased as above stated.
, Date issued ) ('-' 2- P— 6—i Signature ...*it Cwie.c....A. %c..-314PI-P.
1 (Registrar)
CEMETERY OR CREMATORY AUTHORITY SHALL OUT SPACE BELOW
Body was CRENATED on NO V. 22 ig 58 in CAREY HAND CRE.Ifol.V.0.1=1.7(
(State whether cremated, buried,stored, etc.) (Cemetery or Crematory)
Place 01.14A ND Q..,.....E.L.Q.R.I.DA. Signature...CAREY_ AN.D....E#ZE AL 1110.11E...
(S on or kers;007:rg
v.s.#640 BY:
This permit must be endorsed by the Sexton (or by the Funeral Dir tdr where there-ts-n-o-sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.
'c,„ (7 -y .„, `- `
t.c., _6L XJ READ CAREFULLY _ C
REGISTRAR: This burial-transit permit may be issued only in accordance with Section 382.06 Florida Statutes.
FUNERAL DIRECTORS: The burial-transit permit is required for any manner of disposition of a dead body in-
cluding interment, storage, cremation, and transportation. A permit is required for each stillbirth, before disposal
of the body.
Before shipment by common carrier, the body must be embalmed; or if that is not practicable must be enclosed
in a tightly sealed casket or outer case.
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 or of the District of Columbia, as authorization for burial.)
All permits must be endorsed, recorded in your sexton's register, and forwarded within ten days to the registrar
for your district.
TRANSPORTATION AGENT: Be sure that a properly completed burial-transit permit accompanies each body. Do
not accept a body for shipment if fluid or offensive odors are escaping from the case. Fill out the attached
coupon and mail it to the Florida State Board of Health, Jacksonville 1, Florida, within 24 hours after ship-
ment of body. /
PENALTY for violations is up to $500 for each offense.