Binley, Arthur A 21030
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(ttj of Ioutnn—Erattii Eirpartmrnt
OFFICIAL BURIAL (OR REMOVAL) PERMIT
(Issued under the provisions of chapter 114,General Laws)
All the preliminary requirements of law having been complied with,including the filing of a
satisfactory certificate of death, legibly written in durable blac ink, permission is hereby given to
/7-)' Date of issue of permit, i Z 1
(Undertaker) (Name) (Address)
for the re II y.al from and the interment
c ,.1 � (To be filled out in case of pmoval) 7
at 1V/CA 4 (l.-P....4 A (' "of the
Ce ,; ` ` (City o(-47-624-4)
Town)
body of
N (Give full n•..e of decease c
who died A,-/� ` 19 - 1, age `� years _ months days
(month) (day) (year)
Cause of death, C%
X- 6 '' 6 ,. ter.
Residence at time of death, � �
(Number) (Street) ity or Town)
\�`1"1 Was Deceased a Veteran of any U. S. War ��
(Specify War)
V J
tJ4 67reau of Vital Sstics
60 A SYSTEMS, PHILADELPHIA 34, PA.
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