Claud Hansen Schmidt5$
of
STATE OF NEBRASKA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF HEALTH
DIVISION OF VITAL STATISTICS
APPLICATION HAVING BEEN MADE for a permit for the disinterment of the body of
Claud Hansen Schmidt
---------------------------------------------------------------------------------------now lying buried in
____Cemetery, in the ------------------------------- t own--------------
(Give City, Town or Township)
Washington
----------- County of -----------------------------------------------------------
State of Nebraska, and who died on the -------------------------- S _ e c®nd-_________---------------------____--
-------------------------- day of
-------------------may------------------------------- L-9-26 aged ---- 63--- years ,----7 ----- months, 2 .......... days, the cause of death
being ---------------- —heart ---failure
---
---------- on death certificate No
this is to certify that permission is hereby given for such disinterment and removal by
_n------------- -to --- ------------ - -- p- -------
-------- v-cv Rinsted
Cemetery
in the -------------- t Q __________-
County of --------------------- 47TlITt@t---------------------------- State of
effect upon approval of the local board of health at the
of------ - k —s ®d-----------------------------------------------
(State whether City, Town, or Township)
IO Pyla ___ to take
--------------------------------------------------------
--------------------- ----------
(City or Town)
Emmet, Iowa
of------------------------------------------------------------------------ it being understood and provided that nothing herein shall be
deemed as contravening or in anywise modifying or releasing the Regulations of the Department of Public
Welfare governing the Transportation of Corpse or the requirements for Transportation Permit, and all Trans-
portation Companies and Common Carriers will be governed accordingly; and provided further, that where the
distinterment is for the purpose of reinterment in another part o#_ a same cemetery, or in a contiguous cemetery,
the removal shall not be made by any public conveyance.
----------------------------------- -
-------------------------------------
---------
State Registrar.
The foregoing ap lication for distinterment and removal is hereby approved by the local oard of health
ofthe---------------�----------------------------------------------------------------------------------- of l� - ,---- - -------- -------
(City or Town)
State of Nebraska, this__2sP__---- day of____1____ _ _____--------------------------19.
-- -- - ---- -- -
-------------------------- ------
Chairman
----
Chairman Loc+,BB,d of Health.
If a ctty or town Attest- --- 'l -- ----- --- -- -----------------------
affix corporate seat J SecretaryLoof Health.
The ORIGINAL permit should be attached to the transportation permit, and accompany the body to destination. The
DUPLICATE is to be retained by the cemetery where the disinterment takes place.
,