Frost, Montres No.
t
Bfl3^ORSA ` 1
COIEDTTAZ
1840.
E90
Titg of ostoxt-- eattii &patty
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 bla ink, per-
mission is hereby given to
Date of issue of permit, 94_ ;
( yam_..,`
•
dertaker)- (Name) (Address)
for the removal from and th ,interment
(To be filled out in case of ra gval)
at r s the
(Cem.) \ .1 (City or Town) ' •
body of ,
(Give full name of deceased)
`ff ' f
who died ( 194s, age-years months clays
(month) (day) (year)
Cause of death,
Residence at time of death,
umber)
mber) (Street) (City or Town)
Was De eased a Veteran of any U.S.War
(SPecify War)
..(1-;;Le4f7:
Health Commissioner