Lauder, Thomas Lit.. No.__ _ S ] OF NEW YOR I� Begzstered No.. __
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f^„ The Certificate t3f Death, having, een rnished to ,.tts` eguired` the Laws of this `
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�,. btctte, er zo 4,s eby givs c for the,.Burial of
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_ `-t -- Ag' e _'±,____who yUed at, Fort Edward, in the-County of Washington;
on ril'441411''' ''...":-__- - -- ---1.9_�__ he. cause o derv, being- - - '4'
i �,-- _ - .Puce •o IZurial +%__. 1c - F r414
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Name of]fie
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F son incharge... o€ Burial Grc tsnd or
Crematory must fill out this. ` and filet
same'with the Registrar`cif the'l ist t i vhich
the;Cemetery is situate` within ; ven ,ciao
after the t is siti of he body. 4 'b
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