Robert Edwin Jewell173
STATE OF IOWA,
IOWA DEPARTMENT OF PUBLIC HEALTH
Bureau of Vital Records
BURIAL TRANSIT PERMIT
TYPE OR PRINT LEGIBLY. DO NOT USE ALL CAPITAL LETTERS
PART 1. DECEDENT INFORMATION
Name of Deceased Robert Edwin JEwell
(First) (Middle) (Last) (Suffix)
Date of Death April 11 2011 Death Communicable? Yes No X
(Month) (Day) (Year)
Place of Death Onawa Monona Iowa 1111 8th St.
(City) (County) (State) (Street Address or I lospital)
PART 2. BURIAL INFORMATION
Burial X Cremation Donation Removal from State X Other
(specify)
Place of Disposition Blair, Cemetery Location Blair Nebraska
(Name of Cemetery, Crematory, or other place) (City) (State)
PART 3. ISSUANCE INFORMATION
Permit Issued to:
(First) (Middle) (Last) (Suffix, if any)
Address
(Street) (City) (State) (Zip Code)
Signature (in Ink) Date
(By signing, I attest to my right to make this transit request)
A Certificate of Death or Fetal Death has been filed in accordance with Iowa Code, chapter 144.26 - 144.35.
Permission is hereby granted to dispose of this body.
Permit Issued by: Rush Family Care Service
(First) (Middle) (Last) (Buff x, if any)
Address 1629 10th St Onawa Iowa 51040
(Scree (City) (State) (Zip Code)
Signature (in Ink) Date April 15, 2011
(By s g, a es o (g �s permit)
PART 4. CODE OF IOWA INFORMATION.
A Burial Transit Permit is not issued for every death or fetal death, only as provided for under Iowa Code 144.32
144.32 Burial Transit Permit. If a person other than a funeral director, medical examiner, or emergency medical service
assumes custody of a dead body or fetus, the person shall secure a burial -transit permit. To be valid, the burial -transit
permit must be issued by the county medical examiner, a funeral director, or the county registrar of the county where the
certificate of death or fetal death was filed. The permit shall be obtained prior to the removal of the body or fetus from the
place of death and the permit shall accompany the body or fetus to the place of final disposition. To transfer a dead body or
fetus outside of this state, the funeral director who first assumes custody of the dead body or a fetus shall obtain a burial -
transit permit prior to the transfer. The permit shall accompany the dead body or fetus to the place of final disposition. A
dead body or fetus brought into this state for final disposition shall be accompanied by a burial -transit permit under the law
of the state in which the death occurred. A burial -transit permit shall not be issued to a person other than a funeral director
when the cause of death is or is suspected to be a communicable disease as defined by rule of the department.
CPI -09750
588-0002 (07/1997)