The Barre daily times. (Barre, Vt.) 1897-1959, 1904-12-31

Place Of burial......-~.
Date Of burial. .,.......
Undertaken. ...........
Address. ...........
no be Hllsd by person issuing
burial permit)
Medical certinoaae at Death.
Date Of death
Month ..., Day. Year. isos....
/ hereby certify that attended de-
ceased from...... $780,. te.... loo... that
last saw H.. alive on.. .lso,.. and
that death occurred on the date stated
above at.....M.
TO the best OF my knowledge and belief
the cause Of death was as follows:
CAUSE OF DEATH.
(sae Instructions On back)
Chief.
Contributing. ...........
............ .......-~. ...,.... .......,...-
........... ......... ......,........
........... ............ .......s. .............
Duration. -.............s...
Where contracted ...s....s....
signed...,.~"......--..-.,.-
MD.
es......-............-...
Address. ......................
Filed. .......isO ................
Health onieer.
The physician filling out the above mem
toned certincate Of death SHAH within
thirty-six hours after death. deliver the
same to the family Of the deceased, il
any. or to the undertaken or person who
has charge OF the BODY which certificate
shall be filed as provided in section Of
this act and certificate Of permission
for burial entombment Of removal OBJ
tained BY the person who has charge Of
the body, before such dead body shall Be
buried. entombed or removed from the
town or city, When such certificate or
death Is filed with the health Officer,
deputy health officer. or other person as
herein provided. such oficer Or person
shall Immediately issue q certificate Of
permission for burial. entombment or
removal Of the dead body under legal
restrictions and safeguards.
Whenever person dies without medl-
cal attendance. the head Of the household
where such death occurs, or the next Of
kin. shall Immediately notify the health
officer. II there be one, otherwise meme
her Of the local board Of health where
such death occurred. who shall after
proper investigation. and II deemed
necessary by him after an autopsy to de-
terrnins tho cause or DEATH issue GER
tiflcate or death.
whenever a dead body Is brought into
this state for burial or entombment from
any state or territory or Dominion OF
Canada, the health officer or clerk OF
the town or city where It is desired to
bury Or entomb such body shall Issue a
certificate Of permission FOR burial or
entombment upon receiving certified
copy Of the death certificate or the re-
moval or transit permit accompanying
puoh body. issued under the laws Of the
atate. territory, or Dominion OF Canada,
Rvhere the person died.
Nan certificates Of death and All removal
* transit permits died with the health
ofacer, deputy health officer, or other
person. in accordance with the provi-
siops Of this act shan DO returned to
the town or city clerk during the FIRST
week Of each month next following the
month in which they are received
Any physician railing to furnish . GER
utieate d death within thtrty-six hours
after the death Of any human being giv-
ine rus and faithful statement 81 the
sr9 rseslyine certiaeaie o. death Or
cause of such death aud an the other
aers provided %, ID the blank form tor
esatp oerthcates mentioned n this aet'
i ii ~ these facts are ohtainable. shall
& ased aoi less than ten dollars 70 ne
p~u the town or city where such death
sccea
Any health ofiosr. dspaEy hsal'n oIicet
q ether person WIG issues eefthes1e
q psrHtsion for he burial, entonoansn'
q removal Il any dead body Wi'noas
aFa receiving certificate Of death o.
renewal o. tlssnkit psrnt e nele'n p'oz