Vaughn, George Permit for Burial, Entombment or Removal.
Issued to_____ ,7,: Spencer & Son. Inc . No.
z County of Rut1 and, —____STATE OF VERMONT.
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A Town or City of =3)itl <.nd
ZDate of Death October •'( , 192 9
F Full Name George Clinto 4�
n Va ,Ah Age_ E 4_ 1 21
3 YEARS MONTHS DAYS
Place of Death Rutland , Vt .
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Disease causing death t to a r t P'a i l ure__ ,
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w Medical attendant_ Dr . Charles H . Swift
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Proposed date of burial, entombment or removal_ _ _-_ Now - mb..er--1, — 192 3 - —
v41 Proposed place of burial, entombment or removal__ _Glens Fat 1 s , TT_Y________
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zWhat cemetery or tomb_ _—__ __ i i n c Li si C eme t er y
ax Manner of burial, entombment or removal _-__ 1temQ L(i 1 Bur __
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ra' Undertaker. C _ 1_ Spenx er zr, Son Tnc
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a Address Rutl nd , Vt . —
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a A Certificate of death (or removal orra sit permit) having been filed in my office in accordance with
removal
z law, I hereby authorize the_ burial of the body of said deceased person as stated above.
(BURIAL, ENTOMBMENT OR REMOVAL)
; .' City Clerk.
Date November 1, _192 39
This Permit, if properly made and signed,is authority for the burial or entombment in any cemetery or tomb in this State.
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o� z 3 Werebg Tertifg, That I did, on the___ day of 19
-0 0w deliver the body described in this permit to ____
: Sexton or Keeper of Cemetery for _
►Fi NX P•
E ' Signed
tX M .1 5 (State title here.
° / . 1939
►-4-+ I 3.0° . h ertify, That I di , on the________/ day of
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I .V� g y (State what disposition w ode of/the body.)
I F d.0 the body described in this permi . _ / / �,
nio Li) °zdo Signed Iiiktileaagg
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