Ainsworth, Hazel FLORIDA STATE BOARD OF HEALTH
Burial Permit No �'O
BURIAL-TRANSIT PERMIT
Full name of deceased Hazel Sarah Ainsworth
Place of death Gulfport Pinellas Florida
November 23 58 W (County) fe 68
Date of death 19 Color Sex Age
Method of disposal removal
(Whether burial, cremation, transportation, storage, etc.) (Cemetery or Crematory)
County Glens Falls State New York
A certificate of death having been filed as required by the laws of this State, permission is hereby given
to J. Douglas Baird License No 764
(Funeral Director or person acting as such)
to dispose of body of said deceased as above stated.
Date issued 11-24-58 Signature._.. 7...7„...,...7..,:e4
�`�
(Registrar)
EMETERY OR CREMATORY AUTHORITY SHA L FILL OUT SPACE BELOW—
Body wa +. b24 _,( ./ : Y on /. / 19 in..r,=-'i",..." ( e.- -:-.6 •
State whether r d, busied,abottd, etc.) (Cemetery or Crematory) :
Place...,. ..: -- `-�2 '7 Signature.. --'Zl' yeo ---r. .,`4' c-1r2"-Z-
(Sexton or person in charge)
V.S.#640
This permit must be endorsed by the Sexton (or by the Funeral Director where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.
READ CAREFULLY
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.