Theobald, Mabelle :XAS DEPARTMENT OF HEALTH PERMIT
IREAU OF VITAL STATISTICS BURIAL-TRANSIT PERMIT NUMBER 5
1. Full me of eceas d ���777 2. Date of death(month,day,and year) 3. Death due to ❑
RSONAL g A '`,l 9 ^ G communiepblp YES TA ON
jL/ 1 41/1 `f/ .5"-zed di NO
:CEASED d.ii-i t 5. Co;r or race 6. A in years 7. Place of death ( . • eJ no.) / (county) (stet
44/4_
Method of Burial ❑ Cremation ❑ Place of bxia !' emetery or rem orium) (city or town) (state)
removal or
NNER AND disposal Removal Disinterment❑ disposal �( � � �
ACE OF Na of Tuner l actor License number nesa address
rr�'���, �j'' �Q / �y yy� s (VV/
iPOSAL ��iC.[// `�?'J�G�e•-e?)y�'-c.--- i%•`/�j 6 Gi �ii/G-(t: ' 1"lL / /--�'
Na f embol (if now write o Li liar* Business address t' t ,
0lie
THORIZA. A certificate of dea having been filed as required by the IQw5 of Texas and all lows and regulations governing the preparation and
OR disposal of dead bodies having been complied with, pernAssion is hereby given to dispose of the body as identified above.
)N TO
,POSE OF
DY Signatur o lo'eJ regis r �irict (city or precinct no.)„ (county) Dote �_
UJII ‘ate
�^y�� T- 0e �� �1)Body was (�I� G �Nome of cemetery or crematory
POSITION Buried ❑ AN., ..)
BODY Location (city or to4n) (county) (state) Name of sexton or person in charge
Cremated❑
READ CAREFULLY
REGISTRAR: A burial-transit permit shall not be issued until a certificate of death or of stillbirth(fetal death)has been
filed as required by the Texas Vital Statistics Law and the regulations of the Texas Department of Health Resources.In
special emergencies, you may, at the expense of the applicant, telephone the State Bureau of Vital Statistics for
instructions.
FUNERAL DIRECTOR: A burial-transit permit is required for any manner of disposition of a dead body, including
interment, storage, cremation, and transportation. A separate cremation permit shall be obtained if required by the
provisions of Section 2,Article 969,Code of Criminal Procedure.A burial-transit permit is required for each stillbirth(if
the period of gestation is 20 weeks or more)before disposal of the body.
When used as a transit permit for transportation by common carrier,the burial-transit permit shall be enclosed in a
strong envelope and attached to the shipping case.No separate transit permit is required.
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
the District of Columbia. -