Elaine E. CleaverIOWA DEPARTMENT OF PUBLIC HEALTH
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IOWA
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SIGNATURE
A CERTIFICATE OF DEATH MUST BE FILED IN ACCORDANCE WITH IOWA CODE CHAPTER 144. PERMISSISON
IS HEREBY GIVEN TO DISPOSE OF THIS BODY.
SIGNATURE TITLE
PERMIT
ISSUED ADDRESS l LA���
BY:
CITY L �-� STATE
DATE ISSUED
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NOTE: A BURIAL TRANSIT PERMIT IS NOT ISSUED FOR EVERY DEATH, ONLY UNDER THE PROVISION OF IOWA
CODE CHAPTER 144 SECTION 144.32.
BURIAL TRANSIT PERMIT 144.32
If a person other than a funeral director 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 dead body or fetus from the place of death
and the permit shall accompany the dead 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 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 occured.
588-0002 Rev. 10/93
CPL -09750
BURIAL TRANSIT PERMIT
NAME OF DECEASED ) ) W , ' � 1 ���� �-
-
DATE OF DEATH i ® DEATH COMMUNICABLE YES
PLACE OF DEATH
CITY OR TOWN TOWNSHIP (IF KNOWN) COUNTY
F
STATE
dal
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,
REMOVAL
CREMATION
OTHER:
El
BURIAt,.�
PLACE OF DISPOSITION
CREMATORY
CITY OR VILLAGE
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COUNTY
STATE
CEMETERY
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FULL NAME
1
) Jen -ss� �mCA'rj
ADDRESS CITY
STATE
PERMIT
ISSUED
TO:
SIGNATURE
A CERTIFICATE OF DEATH MUST BE FILED IN ACCORDANCE WITH IOWA CODE CHAPTER 144. PERMISSISON
IS HEREBY GIVEN TO DISPOSE OF THIS BODY.
SIGNATURE TITLE
PERMIT
ISSUED ADDRESS l LA���
BY:
CITY L �-� STATE
DATE ISSUED
f--eb , i�
NOTE: A BURIAL TRANSIT PERMIT IS NOT ISSUED FOR EVERY DEATH, ONLY UNDER THE PROVISION OF IOWA
CODE CHAPTER 144 SECTION 144.32.
BURIAL TRANSIT PERMIT 144.32
If a person other than a funeral director 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 dead body or fetus from the place of death
and the permit shall accompany the dead 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 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 occured.
588-0002 Rev. 10/93
CPL -09750