The above to be filled out by Undertaker and attached to box containing corpse.

The above to be filled out by Agent or Baggageman at the initial point showing description of ticket, exact route, and via what junction points the ticket reads.

I Hereby Certify, That the body of..

.date..

.189....

..named in this transit permit has been prepared by me for transportation in accordance with the rules of the State Board of Health by being..

If Disease be Infectious or Contagious, Undertaker must make following Affidavit.