Wright, Mildred Form 4 V.S. The Legal Fee For This Permit Is $1.00 Reg. 1
Dec. 61
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STATE OF NEW JERSEY BURIAL OR REMOVAL PERMIT V,.
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Dover Township, Ocean County Dec . 14, , 19 70 e
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(City, borough or township and date) b a,v a,
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The Certificate of Death having been filed with me, as required by the laws of this State, permission is .5 a u
hereby given for the removal, burial, or other final disposition of the body of y 3
Mildred R. Wright • .Y. •G
93 F Dover TownshipDecember 1 0 tii
age sex who died in on 19 ?
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Cause o f Death
Pulmonary Embolus voa�
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Proposed Place of Removal, Bur' or . '4 o
other Final Disposition Burial_ View Cemetery, Queensbury, New York V °.i CI
Place Location .n v G.ti
Funeral Director 3 v
Anderson & Campbell
703 Nain St . , River, .y.o v 2 CI Y Toms N.J .
(Address) (Registrar of Vital Statistics) . 8" >.
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Penalty For Burying Without a Permit, $5 to $100 2 2
STATE OF NEW JERSEY
BURIAL OR REMOVAL PERMIT
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(Name o Deceased)
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(Date of Burial or
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(Signa re of Superintendent of Cemetery p '"aolou arto
This permit must be delivered to the superintendent of
the cemetery or crematorium where,burial or cremation is to
take place, who should fill in the spaces above and forward
it within ten days to the registrar of the district in which
the cemetery or crematorium is located. Registrars are usually
health officers, city and borough clerks and assessors of
townships.
When burial takes places in a cemetery which has no
person in charge, the spaces above should be filled in by
the funeral director, who should write "no person in
charge" on the line for signature of superintendent of
cemetery and file the permit with the registrar of the dis-
trict in which the cemetery is located. The law requires
that this be done within ten days after burial.