Slade, Isaac E+'orrn 5. f
f# jSwAnVER OF NEW K*
f
Im E PAR M Imo' .
o lame of Town
(Village) and County, .... ... . .. .. ......... ... ..:...... .. ,........ . ............... .
I ne Certificate of Death having been furnished Ionic, as required by the.haws of this State,permission
CL is hereby given for the Burial of,....Ia4 ..dye r��
a (City or Towns } .. .... .......
if who stied at. ......................... in the count o f
on. r ....................19 4, the cause of death being.:`
E '4€Place of Burial... ..r .,,.. . :. ................. ......... .......
Undertaker or persrtn f = I
in charge of Bu ial, (Signed b F: . ...
Residers .. .