Devine, Maurice Form A.C.21 6 Books 10-45 Reg. CC46 A.L. 241b.,Canary - .51
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OFFICE OF CITY CLERK No. 3 0
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BURIAL OR REMOVAL P RMIT a 3
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Newark, N. J., ',if"' 19 a�
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The Certificate of death having ben furnished me,•as required by the laws of this State, permission 3—W
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is hereby give for the burial of oTo
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who died at_ _ _ on y 19 a°'°
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cause of death bei ___Age j / �I — I _ I _ I _'
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� •- �2�%t�, CITY CLERK •P.
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Penalty for Burying without a Permit, $5 to $100
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