Kuhn, Shirley BURIAL - REMOVAL - TRANSIT PERMIT K
Permit No.: `� 73 Death Quarantine Diseas ? Y s N1No
Z Full Name of Dec ed
Place of Death: .UV Qi •
E. / �it (County) J State) ��
Z Date of Death CSL(�, 4� /9/ Race CA, Sex Age
METHOD OF DISPOSAL: X Burial ❑ Cremation tgJ Transportation ❑ Storage
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Wal ❑ Donated to Medical College ❑ Other
O A ERTIFICATE OF EATH,HAVING BEEN FILED AS REQUIRED BY THE LAWS OF
E. TH STATE, ERMISS IS HEREBY G ED TO:
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Z 4 _ / Funeral Home
Q
E (License No.) dre State)
c4 . au jZoZ+ L.R.
ZDate: Q
Q ( ity/Town) (County)
CEMETERY,CREMATORY OR COLLEGE AUTHORITY SHALL FILL IN BELOW:
rj Body was On 19
d (Buried,Cremated,Received)
F., At
u (Cemetery,CremAatory or College)
Located At: •- - _---•
Signed: id:----(. .'L �1(
(Sexton or person in charge)
aThis permit must be signed by the Sexton,or the Funeral Director where there is no Sexton,
to or authorized college personnel, and permanently retained in the Sexton's, funeral home, or
x college files. SEE OTHER SIDE
H
GEORGIA DEPARTMENT OF HUMAN RESOURCES
OAS(5)-34 Vital Records Unit
(Rev.6-76)
READ CAREFULLY
Please become familiar with the rules for the transportation of the dead.
REGISTRAR: This burial-removal-transit permit may be issued only upon receipt of a
death certificate;not before.
FUNERAL DIRECTORS:The burial-removal-transit permit is required for any manner of
disposition of a dead body including interment, disinterment, storage, cremation, and
transportation.A permit is required for each fetus disposed of by a funeral director.
When a body is donated to a medical college it shall not be embalmed.
When used as a transit permit for transportation by common carrier, this permit or
duplicate thereof should be enclosed in a strong envelope attached to the shipping case.No
separate transit permit is required.
Before shipment by train or express, the body must be embalmed; or if that is not
practicable must be enclosed in a tightly sealed 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-removal-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 and retained permanently in your files.
PENALTY for violations is provided by laws of Georgia.
QUARANTINABLE DISEASES are: smallpox, plague, Asiatic cholera, yellow fever,
typhus fever,diphtheria(membranous croup or diphtheric sore throat),scarlet fever(scarlet
rash or scarlatina),erysipelas,anthrax and leprosy.
OAS(5)-34 (Rev.6-76) (Reverse Side)