Brogan, Jane FLORIDA STATE BOARD OF HEALTH
Burial Permit No.....ra.LC.
BURIAL—TRANSIT PERMIT
•
r Full name of deceased. .g....ale0C ,.s.-e
! Place of death. .x1.QtatiLIAc ,. 1 GA.Q� .Florida...._
(City) t y I r�(County)�
Date of death..... .le 2.-...1.:7i 19. i7 Color tCrYi-LrL....... x Qi Age 5 3
r ��,, nn
Method of disposal..._.. '!'ati(.1.0,Q iC41.A.:121.4.1,t,)
(Whether burial, cremation, transportation, storage, etc.) (Cemetery sr Crematory)
County . 9... state `t12,..,11 Lift:9
i A ce fi ate oft rd9ath h vying been filed as required by the laws of this State, permission is hereby given
to 1.,"C kkQ..i.C. . ti:1,43 r License No E(C.`
i (Funeral Director or person acting as such)
i to dispose of
body� of said deceased ass above stated. /y� y ,--A p
Date is sued. l.ihi�e.(�/Y1� t /- ,J.q(.7. Signature..:f r al Qk a c .. ..A
I (Reg rar)
r CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW "
Body was ".‘' 7.--'/ on 19....i in. 7 e 7(State whether cremated.buried,stored, etc.) _ (Cemetery or Crematory)
)
Place .- .s " Signature
(Sexton or person in charge)
1
Y.B.iB4O
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
eluding interment, storage, cremation, and transportation. A permit is required for each stillbirth, before dispose
of the body.
Before shipment by common carrier, the body must be embalmed; or if that is not practicable must be enclose
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 othe
disposition of a dead body before a burial-transit permit is deposited with him. (The sexton may accept th
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 registra
for your district.
TRANSPORTATION AGENT: Be sure that a properly completed burial-transit permit accompanies each body. D
not accept a body for shipment if fluid or offensive odors are escaping from the case. Fill out the attache
coupon and mail it to the Florida State Board of Health, Jacksonville 1, Florida, within 24 hours after ship
went of body.
PENALTY for violations is up to $500 for each offense.