Harold MichaelsonTDH
a
Name of Deceased - First
Middle
Last
Harold
Michaelson
Age
Sex
Dale of Death
Method of Disposal
Male ❑ Female
Removal ❑ Cremation CJ Burial
82
Februar 23 20F,a3
Place of Death
City - County
State
South Padre Island
4100 Gulf Blvd. Unit 402
CameronR@Ktx1xHhH
Texas
Name of Cemetery or Crematorium
City
State
Blair Cemetery
Blair
Nebraska
Print - Name of Funeral Director or Person Acting as Such
Address
City Slate Zip Code
Juan Carlos Sierra
395 S. Sam Houston San Benito Texas 78586
Print - Name of Local Registrar County City or Precinct Permit Number
Bennie Ochoa, III I Cameron I Port Isabel
A certificate of death having been completed in so far as possible and presented to the Local Registrar; permission is hereby
given for final disposition, transport, or removal of the body from the state of Texas.
�- Feb. 25, 2003
Signature - Local Registrar Date
Received by: J fi n ro "� terra Date Feb . 25 , 2003
VS -116 2/2001
A Burial -Transit Permit is required to ship or transport a body out of Texas, or to transport a body by common carrier within
Texas. A Burial -Transit Permit is also necessary for cremation.
In accordance with state statute, before a dead body can be,lawfully cremated, a Cremation Authorization must be signed and
issued by the medical examiner or justice of the peace of the county in which the death occurred showing that an autopsy was
performed or that no autopsy was necessary. If an inquest is being conducted by the medical examiner or justice of the
peace, authorization for cremation from the medical examiner or justice of the peace is required. If an incomplete death
certificate is used to obtain the Burial -Transit Permit, the local registrar will validate that the body is no longer needed by the
certifier of cause of death before issuing the permit, to ensure that a completed death certificate will be received.
The Burial -Transit Permit will bear the name of the local registrar of the district in which the death occurred or the district in
which the body was found and is issued by the local registrar, the registrar's deputy, or some other authorized officer. The
local. registrar shall not issue a Burial -Transit Permit until the Certificate of Death, completed in so far as possible, has been
presented.
"Completed in so far as possible" means the information relating to the deceased, including the name, date of death, place of
death, funeral director's information and manner of death is completed. In a few instances, the cause of death may not be
completed.
It is the responsibility of the person presenting the Certificate of Death, and obtaining the Burial -Transit Permit, to assure that
the fully completed Certificate of Death is filed with the local registrar as soon as possible. A permit number may be assigned
by the Local Registrar as needed. There is no fee authorized for the issuance of a Burial -Transit Permit. The local registrar
upon completion shall retain the canary copy of the Burial -Transit Permit for three years.
[HSC §193.008, 25 TAC §181.2, §181.3]