State Board of Health of Florida, Bureau of Vital Statistics Burial or Removal Permit for Infant of Sam Johnson, stillborn. Undertaker: Holmes Funeral Director

Holmes Funeral Home

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duv^lCountyReg. Dist. NoBURIAL OR REMOVAL PERMITSex ColorFull nameDate of DeathDisease causingPlace of burial.Removal to via'Address.UndertakerRegistrar’s signature.DatedDate of interment.Sexton’s signatureA certificate of death having been filed in my office in accordance with the Laws of Florida, I hereby authorize the body of said deceased person as stated above.Burial permits must be delivered by the undertaker to the sexton or other persons in charge of the burial gropnd or cemetery where burial takes place. When the body is to be shipped to a distant point, requiring the service of a common carrier, in addition to fbe removal permit, the body must be accompanied with a transit permit as required by the State Board of Health. For full particulars see Rules and Regulations Governing the Transporta­tion of Dead Bodies.STATE BOARD OF HEALTH OF FLORIDA Permit NoBureau of Vital StatisticsInc. Town ____________ ....____-or JACKSONVILLEThis permit must be indorsed by the sexton and returned to the Local Registrar of his district within ten days. If there is no sexton or person in charge of burial ground, the undertaker or person acting as such shall sign same as sexton, giving date of interment. Wr ite across face of permit the words, "No person in charge,” and return to Local Registrar of the district in which interment is made within 10 days.Precinct______________________ ___ ____(Write name, not number)

Burial Permit: Johnson, Infant

https://digitalcommons.unf.edu/context/rghw_removal_burial/article/1109/viewcontent/RGWH0688PAr.pdf

Burial Permit: Johnson, Infant

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