Harris, Shirley R-3°9-°8 0.4e Truttmonwettith of igasarilusetts
R-309-08 No. 10(!)
No
OFFICIAL DISPOSITION, REMOVAL OR TRANSPORTATION PERMIT DISPOSITION, REMOVAL AND
(Issued under the provisions of Chapter 114,Section 45,General Lows,Ter.Ed.,as emended) TRANSPORTATION PERMIT
77Os permit can be signed only by the agent of the Board of Health(or In town,where there Is no Beard of HeeNit by the town cleric)of the city or
town In tenth the death occurred AFTER the FILING and acceptance of a satiatectory cenificate of death,printed or typed in permanent Weak Mk.
This Section to be returnedendorsed Immediate o the issuing City/Town,properly s
City/Town cgaca- 8612AAir.@_ Date free o 201/ to Plan f33.e..1 r\02-1 A ' t
(Office issuing permit)
A satisfactory death certificate having been filed for
?..-/ik.4::.y /4:)/V/V / a4el5 Cityrrown of G 4 80A7u.r.8161\- Mass.
Full name of decedent
,,,....
US War Veteran — —who died on
Name of Decedent 0://74./..-5...Z.221(&...14 .:?.(eet-21:
.f.`:e2A.1.241/,,(;?.e..C./.....a."..., cr'lei/i/ ^--
c..-1 date of death
born on st:444./.1(..?..j.„.54../..f.../7...5 who resided at If a U.S.War Veteran,specify what war,organization,etc.
date of birth -_ ----
/ Z/i/ett?.7:-0
ENDORSEMENT
and who died of (To be filled in by cemetery or Crematory official)
give immediate cause
Permission is hereby given for(check all appropriate boxes):
hereby certify that the body accompanying this permit was
II-Removal from: 46*A /( 2Zy...f.`91r4V4,6-:.44.57,4-2/.464-.-69// ,77," disposed of in accordance with its terms
fiame nd address of original disposition
at 191+%1 0 i eV Crril-set—Uf i VI.„,
I 1 Disposition at: (Name of cemetery or crematory) (City/Town)
name and address of cemetery or crematory .
Wrransportation to:44y.fiet4, -.4--4.4y.,.....":;%/e/14,'T.r.a/,/,..1",...i.V.,y, on 44ip. Ploge.el 1 2Q.li
imme nd address of immediate destination of remains'
Permission is hereby given to: Final Disposition ii'l Ls f C(„ i . '&43 iii
,... / •
A4x- 7/rz--7i7e Certified by . .„1,„
facility
, 'Crla /27&&.. 7- qte.2. .?:'A9.,t." .W...717"g.4J,z,z37,7 (Signature i Superintendent,cemetery or crematory)
address of futility
f)1V2L-r4.4' 1 ... II If there is no officer in charge,funeral director must sign and return this stub.
IF
Signature of Board of Health AB or,its towns sets• there is no Board of Health,of Town Clerk)
.....
i