Copelaw, Augusta FLORIDA STATE BOARD 9F HE19E.,TH,,
Burial Permit Nol, v .
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BU AL-T ANSIJ P MIT 462.4.4 j
Full name of deceased.
Place of death. Florida
(ci ) (County) -
Date of death )"..1".. 196)1 Color Sex
Method of dispo 1.
(Whether burial, cremation, transportation, storage, e ) (C tell, )
Count State
/tif of death aving been filed as required by therg this S te, permission is hereby given
to. 471 • License No
/ (Funeral Director or person acting as such)
.• dispose of of said celas% as ab,.vistated.
Date issued.. .. .. ... .... ... i2t..1.9.6)..?‘ Signature... e ) 4,
(Registrar)
CEMETERY OR CPAMATORY AUTHORITY SHALL,' FILL OUT SPACE BELOW
Body was 114.:.,:-....i.1.1 on . \"-4. 4 ft,
191.1.... in.
(State whether cremated, buriedjstored, etc.) (Cemetery or,Crematory)
' 1 ‘'i
Place ler -- 1 . L'' '. ' . '1 Signature )ii t' : " ( I 1-:,
(Sexton or person in charge)
V.S.1040
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 Heath, Jacksonville 1, Florida, within 24 hours after ship-
ment of body.
PENALTY for violations is up to $500 for each offense.