Unknown (2) Form D
.._ STATE OF MAINE BURIAL PERMIT
1937
Permission is hereby given
to rentO and b7 the remains of
. .e.1.4e t.
in .t...e e. 7 44:t4A- Cemetery, Town of
Date of Death , /r .19,?7, Age t ryears ///iiit:(9•1thspaid a7
Place of Deat ./‘ r Street.. / -
Caf Death, ILwt
/'
..-- ../
./ 7/I-e- /7e /VID'
Medical Attendant11---t—e—a / -_t - „
No. :---";;)-- City or Town Clerk
(Over) e
_....
(Ah--444 0 -1
`1 `�, 1g37 _ 1
•
Signature of person aving charge of cemetery
This Permit must be returned to the Clerk of the town or
city in which the burial takes place, within SIX DAYS after
burial.
Any person acting as Undertaker without a Burial Per-
mit will be subject to a fine not exceeding one hundred
dollars.Chap. 1, Public Laws of 1933.