Van Thompson, Grace FLORIDA STATE BOARD OF HEALTH
Burial Permit No...4 .6'. .2/-
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BURIAL—TRANSIT PERMIT
Full name of deceased -- 11ifittr...-e— tia4",- .7
Place of death ... 9‘)) . .,:w.313re--- - Florida.
Date of death y . 196...q Colorc-A" '-4--4,-- -( . z raf x.7-°rie.-62-14—
v\ Age 0(
Method of dispos 1 e-fr--'-21,<--a. I
(Wheth r bur , cremation, transportation, storage, e .) )ekrie...4X.2...—h-Nry
County State
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certificate p7 der License No it h h jr.1.43efern,..,,./ed as required by the laws of this SUL*, permission is hereby given
to.
uneral Director or persob acting as such)
to dispose of body of said deceased as above stated.
Date issued APR 12.6a Signature .2t .,41-1.
(Registrar)
C METERY OR CR TOR zY AUTHORITY SHAIAJ FILL OUT SPACE Blg,Q
Body was on 194ff in.
____—• (State, hether cremated, d,siessdinte.) cy (ptery Crematory)
Place fej74-fr-kr 4-1 %,...12 ' ' Signat
1 - -
(Sexton or person In charge)
V.S.#640 ,
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 Health, Jacksonville 1, Florida, within 24 hours after ship-
ment of body.
PENALTY for violations is up to $500 for each offense.