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Minor, Louis `� %' e Na. 0722 HOST©COXIMAJD 0 A iti of rigton— Irttitll Brpttrtntrtt# OFFICIAL BURIAL (OR REMOVAL) PERMIT (Issued under the provisions of chapter 114,General Laws) All the preliminary requirements of law having been complied with, including the filing of a satisfactory certificate of death, legibly written in durable black ink, per- mission is hereby given to ') Date of issue of permit( , f I""" 194�+ / ---.‘ erndertaker) (Name) (Address) f folio removal from and the interment (To be filled out in case c.removal; at tP of the (Cem.) (City or Town) ✓` body of J ! .1 � /� (Give full name of deceased) who died / � 194 , age years months days` (month) (day)- ( (year) Cause of death, C.Zet.. i l>&-Is.44,- ) h a: y4 ,1 V Residence at time of death,/4"ed .. ' ' i (Number) (Street) (City or Town) Was Deceased a Veteran of any U.S.War Q (Specify War) .X),ZCI P Health Commissioner