Bullard, Harold %z 6 No.A-285 �+`'1 COFY,D84v�dfs
y,, SII0 4?8
� E DO�P
Q itti of Boston--11ralt.l 3r iartntrnt
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
k s%, s
} ) F Date of issue of permit,_ d 19
(Undertaker) (Name) (Address)
for the removal from and the interment,
(To be filled out in case of removal)
at
: 'j ti I'r,-' i �,,-r,,.' a %ti•..,-. of the
(Ceres) / . (City or Town) r
body of r �•'�.! 77 /c,,,
(Give full name of deceased)
,-.7, kit
who died 19 , age r years_ months 7days
(month):• (day) (year)
Cause of death, 0.r/.It„p_e'0* Cy, e 4,41
Residence at time of death,
(Number) (Street) (City or Town)
Was Deceased a Veteran of any U.S.War
(Spe /.y )
-
Health Commissioner