Sanders, W _. """ 4 Dist. No. STATE-OF NEW YORI� Registered No..
aa
a� 0
oyy
W o•a.5 4 BURIAL PERMIT
o
caa^ .i Town (Village) of Fort Edward, Washington County, '2- 19_
U v.va The Certificate of Death, having been furnished to me, as require . by the Laws of this
� v
vb� �w
Z(74 ��w v o State, permission is hereby given for the Burial of __ ___ `- _ -_ '"�—
z Eby
c:// � v o Se "- Age!Is Z 0who died at, Fort Edward, in the County of Washington,
Z ' `, on "` - '� 3 19_/� he cause of death being- ---- ..� ---
a � i i%Cc�t, ��� Place of Burial
4-1 tk.
0 v 1 [l�'�4� •ti
cif � p "o � Zlndertaker or person
II
v pa o f Burial,"b�o :� ownClerkandreterofV. S.
�,�c- H Residence
�� egiiN
f
,
BURIAL PERMIT
Name of Deceased
-- I ,
Person in Charge of Burial Ground or
Crematory must fill out this part, and file the
Same with the Registrar of the District in which!
the Cemetery is situated, within seven days'
after the disposition of the body.
•
ti„,
ate of}
Creuipn L/ 19(61
Signed 47-: -
(- .
4
I
Filed t9
- i
' 1
Registrar of the Town and Village of Fort$dward,N.Y.