Wallace, Harriet FLI No. 17,851
Burial Certificate from the person in Charge of Crematory,required by
F.T4
General Laws of Massachusetts,1921,Chapter 114,Section 48
p-4
Springfield, Mass., Eab.r.uary...12,, 19 69
P14 I, G... Do.aald. kik4110.11 being on this date the person having charge of the crematory of the
P-1
ci) Proprietors of the Springfield Cemetery,hereby certify that the burial permit and the certificate of the medical examiner
FT-1
prerequisite to cremating the body of BARRIET WALLACE
E-1
late of 107. lielsfari
0
c") who died at have been duly presented.
(24
H° Date of death Fehr.u.ary .1Q, 1969 , age..9.2 years 2 months 23 .days.
Cause of death Arter.i.o. Ja.eart.
P-1
0
General Manager
44
Form 7-1M-10-67 The Proprietors of the Springfield Cemetery.
E.-•1
krz-% 4/4