Rider, Margaret STATE OF MAINE BURIAL PERMIT 4-
64/WAY'. Me., a Of /O .19 y2—
Permission is hereby given ,,.to remo 2 ,,, dirdsthe r ills of r 41 &- (I
in 1, Cemetery, Town of_ 'i• •
Date of Death...167W22.,.-_-19 , Age.kears months days
Place of Death____ S reet_ 63
Cause of Death_ pr.'
Medical Attendant
(Over)
"t
Signatu of person aving harge of cemetery
This Permit must be returned to the Clerk of the town
or city in which the burial takes place, within SIX DAYS
after burial.
Any person acting as Undertaker without a Burial Permit
will be subject to a fine not exceeding one hundred dollars.—
Chap. 64, Revised Statutes.