Bold, Elsie _fp ®EEe--ce rrV.,\Er 9 V E/Y/'‘6` Ld IL■r'i6\ 9 tbi 9® •l6 6/ ®L 616.1r%fe66®' �. .,fu" 6 W g66d+6'S9rr 69./
dd BURIAL-TRANSIT PERMIT
BURIAL This perma't'rrtust accompany remains to destination Reo. Dist. No.
RANI 1. PLACE OF DEATH 2.USUAL RESIDENCE(Where deceased lived. If institution:Residence before admission)
PERMIT a.COUNTY PRINCE GLORG MARYLAND a.STATE mARyLANDb.COUNTY FRINGE GEORGE
°s b.CITY OR TOWNN(If outside corporate limits,write 'c.LENGTH OF STAY IN lb c.CITY OR TOWN(I',outside corporate limits,write RURAL and give nearest town)
S O RAifi SYL rre3.liawn) 2 s U ATr VI L E
V t I>t ilAli��iL2J�
m `^ O
m °,2 d.NAME OF HOSPITA f n m s toL gi Ee,�� ress) d.STREET ADDRESS e. IS RESIDENCE
.� o OR INSTITUTION 2�Q Jy !-K , 2007 ERIE TRE( ON A FARM?
• v c YES NOEx
v 0 .
° o' 3. NAME OF First Middle Last 4.DATE Month Day Year
- o DECEASEDOF
d a (Type or print) EL.IE M. BOLD DEATHSEPT. 22 19 58
u 5.SE 6.CpacIf fi RACE 7. MARRIED❑NEVER MARRIED® 8.DATE OF BIRTH 9.AGE(In years IF UNDER 1 YEARI IF UNDER 24 HRS.
3 5 FEMALE I i�i�t�,'j,"D AUG. 1889 last birthday) Months Days Hours Min.
0 0' I WIDOWED IX DIVORCED❑ 6, 69 yrs.
,n r E ISo. USUAL OCCUPATION(Give kind of work done lob.KIND OF BUSINESS OR INDUSTRY 11.BIRTHPLACE(State or foreign country) 12.CITIZEN OF WHAT COUNTRY?
'^
laf ng life,even if retired)
° -., � flGIT Ei}perNEW yor,K U.S.A.
- E E
at 13.FATHER'S NAME14.MOTHER'S MAIDEN NAME
o a o
ii . Unknown Olsen manna unknown
8' E 15.WAS DECEASED EVER IN U.S.ARMED FORCES? 16.SOCIAL SECURITY NO. 17. INFORMANT Address
O E (Ye,, unknown) I(If yes,give wor or data of.erece) s
a ri,°p°r Now:. George A. Bold, 2007 Erie St., Hyattsville, Md.
O '
3• 0� �-
-
a. AUTHORITY FOR BURIAL, TRANSPORTATION, REMOVAL, CREMATION OR OTHER DISPOSITION
g r — This bs,riai-transit permit, when completely filled in and bearing below the signatures of the attending physician and funeral
a o E director, constitutes authority for burial, transportation, removal, cremation or other disposition of the deceased named above.
,,E CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SECTION BELOW
O a•
s The deceased named abovev[ was buried a cremated in the cemetery or crematory named in item 22c. Burial was in
;- `o ,„ o Section -,• -3 Lot 6l[' Grave / .�I tyove made the appropriate entry in the cemetery or crematory register.
CN o m o 4-1t� C/t�r tk ' Signature 7,/l Cis e.
° �; 8Sexton or other person in charge
o a o "o Ya`s This burial-transit permit must be signed above by the cemetery or crematory authority. Where there is no full-time person in
` G,o charge of the cemetery, the funeral director may sign as sexton.
8 ,..av If burial took place in Maryland, this permit must be returned within ten days to the Division of Vital Records and Statistics,
c -a a d
a M 0 • 2411 N. Charles Street, Baltimore 18, Maryland.
co c 21. I certify that I ttended the deceased from. 1 J ` , 19_____, to .. _, 19 __',that I last saw the deceased
a. -c�.o olive on , 19 -' , and that death occurred at_ 1, from the causes and on the date stated above.
$= u e �^{{�- }* IL ADDRESS(Street,City or town,state) DATE SIGNED
o m f3 0 1 AGNCTUAL ,
-PURE ~ A-- M.D. 1 y"!�. 1 D „Al, ,q„, h r
� � o c PHYSICIAN'S py p� t Q ) t t ,/
ei a E. . m NAME!Type) t"' ':14 ! f[„ M - f i'T S! .
i pus z 22a.DUR!AL,CREMATION, 22b.DATE THEREOF 22c.NAME OF CEMETERY OR CREMATORY 22d.LOCATION(City,town,or county) (State)
4 � T .Alasp `,�'��IAL 9/24/58 PINE VIEW CEh ITPsRY asENN FALLS, NEW VItIC
23.FUNERAL DIRECTOR'S SIGNATURE ADDRESS In using this permit the funeral director certifies that he
vs A15(4) SILVEL PRIN1.' !)' has previously filed a certificate of the death of this
15M 9/55 ' decedent.
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