Witherell, Emmett #r
t STATE OF NEW YORK. Form s.
m
BURIAL PERMIT.
f Name of Town, y / / 0 •
t(Village) and County. ._ ,:.,...�/Y.r. - ___ _......,v_.- It
Cro
RV
(Dated,) I-Le-- 7 zfo
The Certificate of Death havin een furnished to m req 'red by the Laws of this State,.permission is
T. hereby given for the Burial of-- _ — le
,e, _-•--
E (City or Township,)
i who ed at __ .- _ Ari- the County of rry
4iii4.7
con VIM ,2,`!t d the use of de,th being __...- —
Place of Burial'il , wl^. ' / !+ d
p, Undertaker or fierson � /
Ain charge of Burial, • (Signed by) / �
kResidence,_.. _- 47V».__.-.---•--- (Official Tide.)