Smith, Alice :XAS DEPARTMENT OF HEALTH PERMIT
JREAU OF VITAL STATISTICS BURIAL-TRANSIT PERMIT NUMBER
1. Full name of deceased 2. Date of death(month,day,and year) 3. Death due to
:RSONAL ��� ,/�a� y ry p2 communicable p
TA ON `GY.L� e/ 9�GC/ / '�/ 'OJ di NO L3
4.Sex S. Color or race 6.Agrfaon 7. P e of death (city or preprecinct no.) (c�qujf+,ty�)f// (state)
!CEASED (�Ji (Q/ — /61u�l
Method of Burial Cremation 0 Place of burin name of ce ery or piatoor�lum) (city or town) (sst/a�te)
removal INNER AND disposal Removal Disinterment disposal ,[�) �--�A//� *411 e744/� A
.ACE OF Na f funer i director_ /� Licennssee number Business
address
/�
SPOSAL ��, /��7D` v�7� /G'!J u/� � ®
Name of balmy.(if none,write none) t1 number Business address l�
HOR A certificate of death having been filed as r ired by the laws of Texas and ail laws and regulations governing the preparation and
ITHORIZA.IT OR disposal of dea ies having been co ' with,permission is hereby given to dispose of the body as identified above.
TO
SPOSE OF Signature o al r t �' • iv (cit
IDY y or precinct no.) Jen(county) Date
Body was Date N e emetery or crematory
SPOSITION Buried Er / 4...--7L_.2 ge/2 Cemc?le,
BODY Loc io (city or town) (county) (state) N o s oon son i charge ,
Cremated El 1/ 1 _./ee/ les ♦ Li f7 4 io-aktJ I 0
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. 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.