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R-309
KEVIN H. WHITE WEEK—END PERMIT No.
U
SECRETARY OF THE COMMONWEALTH BURIAL (OR REMOVAL) PERMIT
WEEK—END PERMIT No.
OFFICIAL BURIAL (OR REMOVAL) PERMIT This coupon to be returned immediately,properly endorsed
Division of (Issued under the provisions of Chapter 114, Section 45, General Laws, Ter. Ed., to ffeal ,,h D@p.�,rttw twat
Vital Statistics as amended.)
(Office i ing permit)
[This permit cam be signed only by the agent of the Board of Health (or in towns where there is no Board of Health by the town clerk) of the city or town in which City �T
Adams., Mass.
the death occurred AFTER the FILING and acceptance of a satisfactory certificate
Or Town of North
of death, legibly written in durable black ink.]
.North...Ad,amsi...Mass.. September DA3Q,. 19.Q5 Name of deceased E11cZ......A1.dx.�,C�.i�.....Cra3tg
(Ctyor town) )
If a U. S. War Veteran, specify what war,organization,etc.
A satisfactory certificate of death having been filed, permission is hereby given to
.Reg.an...&..Denny Glens...Fa11s.,...N4....Y..
(Name) (Address)
for the removal from N.Or.th..Adams...1-iospit.a.1 , and the interment �
(To be filled out in case of removal) ENDORSEMENT
at .P.ine...uiet( Cemetery in Que.ensbury.,.N.., oYthe
(To be filled in by cemetery or crematory offiicial)
body of .E11.a....(,A.1dri.ch)....Crn.i•g who died .Sg..pt• 3Q,,....19...Q.5
(Give full name of deceased (Month) (Day) (Year) I hereby certify that the body accompanying this permit was
age 75 years, 3 months, ....23 days. disposed of in accor ance with its terms
v
Cause of death ...B.r.a�.n....il�'If1U.r.I'.k1r` ge at ' �` ., (�� /r .�J/ e.�/
�� (Name of cemetery of crematory) (City or town)
If a U. S. War Veteran, specify what war, organization, etc. —
on --e / c' la' 6 /
Residence at time of death Czl ns...F.al1s.,....RL.....Y.. Certified by G.:7..s: ./� ......... ?LY.�(:SJC,,,.
(Signature of Superintendent, cemetery or crematory)
' ,
(Signature of Agent o:Board of Health.or.in towns where there is no
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