Phelps, Andrew .v: Dist. No d.7_5:_`i STATE OF' NE'4V`'YORI� Registered No.
wce
p BURIAL PERMIT
Q "FA TownVillage) ofFort Edward, Washington County,IOQ trkr� � 19_`)-Z
U ,�.� co Certificate of Death having been furnished to me,as required by the L,ws o
4.
Z . v .N �, this State,permission is hereby given for the Burial of s..4 __'_
r c,b a cce
Z b o gl) a SexY ' -'--' Age_If b who died at Fort Edward, in the County f Washington
ego o
v^ on_. b 199.._� the cause of death bein _ ' ► _ ? ,
a �w 0 -O-- ,'! ---ce
� ' - -- -- -Place of Burial------ ___ It_
ti
o-
,. m_y +,
o a Undertaker or person -1.p....)_1.A..____,_,L../.- 4
Z q4.
d
0=. a in charge of Burial, _ `� _ _' ,
.- K :� Town Clerk and Registrar of Tr S.
"y E H Residence
BURIAL PERMIT
Name of Deceased,
Person in Charge of Burial Ground or
Crematory must fill out this part, and file the
same with the Registrar of Health, within
seven days after the disposition of the body.
Date of{Interment
Cremation _ 19
Signed
4
Filed S 9
Registrar of the Town and Village of Fort Edward,N.Y.