Schaff, Jr. Frederick R-309-10 � It ( 111ririmD11w aIt1 of Jtl: ass arI tctf //— 3 7
. R-309-10 No.
No..L — �
OFFICIAL DISPOSITION, REMOVAL OR TRANSPORTATION PERMIT DISPOSITION, REMOVAL AND
(Issued under the proelelona of Chapter 114,Section 45,General Laws,Ter.Ed.,as amended) TRANSPORTATION PERMIT
This permit can be signed only by the agent of the Board of Health(or In towns where there la no Board of Health by the town clerk)of the city or
town In which the death occu R Fl NG and acceptance of a satisfactory certificate of death,printed or typed In permanent black ink This section to be immedla y to the Issuing City/Town,properly endorsed
City/Town � D ' 20..'/..... to //k/J�//1 r/
(Office issuing permit)
A satisfactory des certif`i�c�a having teen fil for
7C.C. e C7 c A R JCAC City/Town of ... C/. Mass.
/ Full name decedent WWII: j.�' /,� / 14 S !`,,.�y_
who died on 1 // II!! /� �yUS War Veteran Name of Decedent✓ )t(� U 4
JGl t/407 �stggf death 1 7 9 d W W organization,.(�,/j�/,L If a U.S.War Veteran specify what war,o anization,etc.
born on 1 ,who resided at
,ce
/,./0/ t 4' --/, A k- /?Pgi. ENDORSEMENT
and who died of `e'` V a y t5J C c* /q.— 4 f€e.r( (To be filled In by cemetery or crematory official)
give immediate cause
Permission is hereby given for(check all appropriate boxes): I hereby certify that the body accompanying this permit was
[ ]Removal from: disposed of in accordance `with its terms
�.we aandd address f original dis lion V
„5i p Rile ft." C �r' r7L J�/&Rr° ����/if' at PIMA)Q y,J Cf�►•� { ow
1s osition at: `M•K• J� (Name of cemetery or crematory) ( tty/Town)
name and address of etery or crematory s
[ I Transportation to: on I Al (3% Z LI
name and address of immediate destination of remains �� ; `�S`V,
Permission i ereby given to: Final Disposition 71)
Certified by
S�+"�►c / G/ r acme/AY Aty �* (Si ature 6f Superintenden,cemetery or crematory)
address of fay"ty
If there is no officer in charge,funeral director must sign and return this stub.