Treehouse, Raoul e
FLORIDA STATE BOARD OF HEALTH`
o Burial Permit No.se?
a
y
BURIAL—TRANSIT PERMIT
p Full name of deceased Raoul Joseph Treehouse n District
H Place of death ,dt• Petersburg Pinellas Florida ,,TE CER-
IR tcity> c male
June 1 66 whitounty)
71' Ty
Date of death 19 Color Sex Age
a Removal St. Adol hus
E Method of disposal j P
o�C Glens I+a•f1 her burial, cremation, transportation, storage, etc.) (Cemetery or Crematory)
County State New York
e e of War)
oa A certificate of death having been filed as required by the laws of this State, permission is hereby given is
E to Fred E. Fair License No 839 .. 19.
:40
o (Funeral Director or person acting as such)
u to dispose of body of said deceased as above stated. X
N Date issued June 2, 1966 Signaturef2 � )6A-'Alt— i;i0r7:4j
(Registrar) M. /
1 CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW
ei Body was q; on f 19 k & in......-4 L /y4-1 4--'-c4 i
E (State whether cremated, burie stored, etc.) �/(Ce etery�) ' r
Place .._�- s��~ t -.. Signature —ly �(z.�v.� c��`.e4. ; 19 1a
M.
w v.s.ksao (Sexton or person in charge) fill exami-
This permit must be endorsed by the Sexton (or by the Funeral Director where there is no sexton) and re- •LA\ '•
exed
turned within 10 days to the Registrar of the district in which the burial takes place. Re 3Y
s
t0 ‘. a.. V,� '...i...a.... . _.. 4r.
JA r e) (ATSdress)
the.._t./). .. -- - . .. to hold temporetril and the body
(Undertaker or person havin rge of c ps ) (Inter, re ove,Or lae�wise dispose of [slate how])
1 ... .... (Signed)
Dated ,, •�t �-r_.:�,c:: ..� ;,_ �tr:�-,.,
��� _ Local Registrar
This Permit is sufficient for the Removal (and interment or Cremation) of a�dy to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No, 82) is required.
Form VS. 61, (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
Date of. y- p,l r ["Tv-2''\-i was > ,/ .4 19 41:
(Interment or Cremation /
(Name of Cem ery, Crematorium, etc.)
Section_ / Lot No. - Grave No._____
/Jf r
(Signed) _ -_zi ��.�� ,Eh
(Person in Charge)
Address —-�
, " f e c �-
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITHIN THREE (3) DAYS with the Registrar of Dis-
trict in which cemetery is located.
SEXTONS,FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE. The law
will be enforced. Local Registrars are required, under penalty,
to report violations thereof.