Rossman, Homer FLORIDA STATE BOARD OF HEALTH
i Burial Permit No -./.1/ 2
BUR -TRAN - PE M
;
,
1 Full name of decease
•
Place of death Florida
Date of death
(c y unty)
l Color
Method of dispA a) 19‘ Arrav,40).4 Age g.4 .
1.0
; AIPIF , (whet urial, cremat n, transportation, storage, etc.) en.lete or Crematory)
County f State
A - tific death having been filed as required by the aws of this State, permission is hereby given
I. to7111PrvAiv ArdiT e License No ..3
i (Funera Director or person acting as such)
1 trispose °Vila! of said ecease4 as Vrtated.
a2K7006z,'
, , (Registrar)
CE RY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW
Body was
Cremated on August 13, 1964 in The Moss Crematorium
(State whether cremated,buried,stored, etc.) (Cem tery or remato )
Place Clearwater, Florida Signature 4.-dic
V.S.#6 4 014,, 000k...0 ji isv'24,...,1 7r ,, a. /,74„,...,4.... . ,z ,...s,... (Elexton :zz::7 1 (! ....,
Thlts permite.yenddleg( e‘ltexVn (or by the Funeral DiAr *hrrg.tez...1 0 re-
turned within 10 days the Registrar of the district in which the bu ar tars tor .
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.