Hendrickson, Isaac WWN or NEW WORKS
B'orni h
m r
r N'ameo£Town .r1 Sri2 '
(Pillage! and County. .........................
.(bated,).. ' ' '1SD
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I The artifacate of Death having been furnished to me, as a eq!Lely the.Laws`of this State,permission
is hereby given for the Burial af., :f ,'. . .. r �.
{City or Township.}($ .Age./
who died at. I ? in the county of... ...�..
on.. 19 the cause f death being..' ..' :°.I
Place of Burial.. `
{ Undertaker or person
Sa ned b }. ... r4: .'.in charge of.Burial, " ` ' ( 9 • • ••.
.Residence...... ...�'� ..... .�Z. �" ,.