Woodard, Clarence .-
STATE OF NEW JERSEY .
BURIAL OR REMOVAL PERMIT g
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For Use Only Where Burial Takes Place in New Jersey. IT,1 x•N rt
/ � / < ° rt< Ulf 19 . , sn -oo
`(City or township and date) ,,,to
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The Certificate of death having been furnished me, as required by the laws of this State, permission is C rt� G
5.
Years. Months. Days. hours. R V.
hereby given for the burial of. . ..-:' r . . . . .` '.r7.1 Age G /n 'j 0 o
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who died at. . . . . . . . in the county of.UY. r d o a 0
ity or township) ) 't m , 0.
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on. . ...3/ 19)`s ; the cause of death being . ^°•==1
Place of burial. e-1444 oL �p"�� a ro
(Signed by) o� '�l�v z �.��. •
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Name of undertaker. .�
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``j (Official tide.) F CC*
'enalty for Burying Without a Permit, $5 to $100. 4
STATE OF NEW JERSEY.
BURIAL OR REMOVAL PERMIT.
Name of Deceased.ax111-,,i:al..-.-.f - c.-
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�yr Date 'Burial.
�,/� $,
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. . 77.. .4d'27< .'.04.7/. ./,11-.1.
Signatu 7 o Keeper of Cemetery.
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Note.—Certificates of death, transit permits,
applications for permits for disinterments, per-
mits for reburial, and blanks for births and
marriages, are furnished by the State Depart-
ment of Health, Trenton, N. J., and may be
obtained from local registrars of vital statis-
tics.