Feighlour, Mary �b _` 7 a STATE,
OF NEW yORI� Registered No.----------
�= Dist.No.cn
BURIAL PERNT
o
y RI
\r,i, _ 9
V •i a.- O --___-____
� � �~� y, Town (Village) cf Fort Edward, R'ashington County, --
�+ me, as re • ed by t e,,Laws of this
,� • P'= been furnishe
tt The Certificate of Death,having
r E"" Stag permis ion is 1_ereby givenforhe Burial of---- ton,
Z w�� ---- -__who died at Fort Edward,in the County of Washing
~ b v v Sex�� � Age
04 O 19��-;the cause of death being
-,7, ce ort_4_____4_._a__,_______________ ________
y \i\
___Place of Burial__ _ -`
_Yi L',C ram+ _ _
Undertaker or person `w�-
e i
' 7 ;,' a a in charge cf Barial, l\ f} -D Town Clerk or Registrar of V. S.
( m , �vuu F1 w __
e ebn `"J�2 H Residence--•-
BURIAL PERMIT
Name of Deceased
'` ry]
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, with'n seven days
after the disposition of the body.
Date ofIInterment
j Cremation 19
Signed
Filed 19
Registrar of the Town and Village of Fort Edward,N.Y.
/ i.