Bagenet, John BALTIMORE CITY HEALTH DEPARTMENT L�
BUREAU OF VITAL RECORDS 63 1442
PERMIT NO.
PERMIT FOR
BURIAL OR TH DISPOS TION OF A DEAD HUMAN BODY
FULL NAME OF DECEASED 44r
/ • '
PLACE OF DEATHalrile /7 A 1�� BALTIMORE, ARYLAND
DATE OF DEATH 19 �+ OLOR OR 'ACE SEX i( AGE
(YEARS.MO • AYS)
P CE OF D OSITION (NAME OF CEME ER O CREMATORY ( OCATION)
METH OF DIS OSITION:
ilBURIAL ❑ STORAGE //dd
0 CRE TION 0 DISINTERMENT PLACE OF RE TERMENT (NAME OF CEMETERY OR CREMATORY) (LOLATION
RANSIT 0 REINTERMENT
THE REQUIREMENTS OF THE BALTIMORE CITY HEALTH DEPARTMENT HAVING BEEN COMPLIED WITH, PERMISSION IS
HEREBYhut
y
A,.. .4.771
GIVEN TO // 7eADDRESS /IUNERAL DIRECTOR OR PERSON ACTING AS SUCH)
TO DISPOSE OF THE BODY OF THE DECEASED NAMED ABOVE. /` E • _ } W ii.1f1.
1963 E.
v i/
FEB2 C MMISSION ER OF HEALTH AND
DATE _19 REGISTRAR OF VITAL STATISTIC
6:1LL
PER
CEMETERY� OR CREMATORY AUTHORITYy SHALL FILL OUT SPACE ELOW
BODY WAS 1O _W� ON - sr 1 94,3 IN )IIII-
TATE WHETHER BURIED, CREMATED,E ETC.) (/CEEEME RY OR CREMATORY)
LOCATION'CO`�O - ,�C"'"� ,.• SIGNATURE -Y���`'�7�/- �'
7 (SE ON OR PERSON IN CHARGE)
SEE OTHER SIDE i v (i r
THIS PERMIT MUST BE ENDORSED BY THE SEXTON (OR BY THE FUNERAL DIRECTOR WHERE THERE IS NO
SEXTON) AND RETURNED WITHIN 10 DAYS TO THE REGISTRAR OF THE DISTRICT IN WHICH FINAL DISPOSITION TAKES
PLACE.
VS 152
READ CAREFULLY
FUNERAL DIRECTORS: A PERMIT IS REQUIRED FOR ANY MANNER OF DISPOSITION OF A DEAD HUMAN BODY
INCLUDING INTERMENT, CREMATION, STORAGE, TRANSPORTATION, DISINTERMENT AND REINTERMENT.
WHEN USED AS A TRANSIT PERMIT FOR TRANSPORTATION BY COMMON CARRIER, THIS PERMIT SHOULD BE EN-
CLOSED 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. IF THAT IS NOT PRACTICABLE, THE
BODY MUST BE ENCLOSED IN A TIGHTLY SEALED CASKET OR OUTER CASE.
SEXTONS: IT IS UNLAWFUL FOR ANY SEXTON, OP OTHER PERSON IN CHARGE OF A BURIAL PLACE, TO PERMIT
BURIAL OR OTHER DISPOSITION OF A DEAD HUMAN BODY BEFORE A PROPER PERMIT IS DEPOSITED WITH HIM.
THE SEXTON MAY ACCEPT THE PERMIT OF ANY STATE OR THE DISTRICT OF COLUMBIA AS AUTHORIZATION FOR
BURIAL PROVIDED THE NAME AND LOCATION OF THE CEMETERY OR CREMATORY ARE WRITTEN THEREON. IN
ALL OTHER CASES, THE PERMIT OF SUCH JURISDICTIONS WILL HAVE TO BE EXCHANGED FOR A NON-RESIDENT
BURIAL PERMIT ISSUED BY THE BALTIMORE CITY HEALTH DEPARTMENT.
ALL PERMITS MUST BE ENDORSED, RECORDED IN YOUR SEXTON'S REGISTER, AND FORWARDED WITHIN TEN
DAYS TO THE REGISTRAR OF YOUR DISTRICT.
PENALTY FOR VIOLATIONS IS FROM $20 TO $100 FOR EACH OFFENSE.