Bush, Rose R-300 e.:v Oluilunntuuralt4 of igaurarlittatto R-300
it1 EDWARD J. CRONIN No...
SECRETARY OF THE COMMONWEALTH
Na BURIAL (OR REMOVAL) PERMIT
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OFFICIAL BURIAL(OR REMOVAL) PERMIT 17ifs coupim to be return,/timinediate4, properly endorsed
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Division of (Issued under the provolone of Chapter 114,
Vitat stets/it/ea C7itipter 176,Acts of 1922,Chapter 243,Acts of 1926,and Chapter 48,Acts of 11)27.)
(Office permit)
This permit can be signed only by the agent of the Board of Health (or it.towns
where there is no Board of Health by the loon clerk) of the city or town in which
:1,t.ed.d:r.ti;e9.,c7irruewdriitiFTIfrflaj:1,LING rig.acceptance ofe a satisfootory certidoote City or Town of ., ;,-.. ..47/1:-../.(et.`---1-‘------- Mass.
— •r° f, s /--)' If
" 19.2.‘... Name of deceased
tnn-s-or town) (Date)
If a U.S.War Veteran,specify what war,organization,etc.
A satisfactory certificats,,eLdeath having been filed,permission is herehy given to
...............Z... ., ',i ,37-7---...
(Name) /-Ze)4., L (Address) / - _ ,-1 ,....)/v./
for the removal from --..—.te . :-.4::-..%.:- 1. .-,<e'.-- ,and the interment -
1 ,,,-, (To be filled out in ease of camas • ...-,LIZ...C! 1-,
NDORSEMENTCenit-44-
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at ' 1---'!--'' ' >---'' a) / . / - ' -.1 Cemetery in„,..i 4 0 /2. 4 of*e ..„1--:„1.-12.---.
body of, 1 -*.- A-*/.4.r'I.,- ''' ..4'..i rd who died .4:..f, ........ - 19..q.:. 4'2.e.--4.0-:' ?(To b.11144 6.by"""'t'Y'''crematory°ff''iai)
(Give full name of deceased) (Mouth) (Dar) (Year) -
I hereby certify that the body accompanying this permit was
age...e IL years, cr months, .1 -7- days. . dis7s,of in accordance with its .
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Cause of death ...
......... att2-.f.e•-•-c Z.. ...--'6,...'--
(Name of cemetery or cremators,) (City drZown)
If a U.S.War Veteran,specify what war,organization,etc. C2:,,,,e. , ( 7' 7 / 7‘.5--? .
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Residence at time of death..0--.." ///4'-r/Ye-AC. Z./..- 'jig:::./.../t t.‘ Certified by .---- -i.....04a.:: „Ide-40.2 e--(...„c a.
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S /-evignature of Superintendent,cemetery or crematory- 1.-,,2.. .ok-,
......4gusto of AgentadBooatrdsg47.114T:r.to tow..,where there is no
If there is no°Meer in charge,undertaker should sign and return this stub.