Chambers, Merritt FORM s—H.D.V.s.
DEPARTMENT OF PUBLIC HEALTH
DISTRICT OF COLUMBIA
BURIAL - TRANSIT PERMIT
Date issued
9 GG {
No. _
Name of deceased 171 '_ ________ ___ __ ,, ,- I('' ''' , e<7.7j
Place Q death .---6 a-
.,.-, Date of death 9 -.zc) , 19__ S _ olor 71/ Age
c' -Cause of death
Permi n/G', ereb given f r the re oval of the mains o he above. d _erson by under-
taker _ c �� _" to �f?�
_ _ - � for Interment
Li.; `On 9. �/ 119 -5
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DANIEL L. SECKINGER, M. D., DR. P. H., DIRECTOR OF,PU)<LIC HEALTH
IMPORTANT
This is a duplicate of the permit issued in this case. This duplicate is not to be returned to the Director of Public
Health, District of Columbia, but must accompany the remains to their destination.
P-3955
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