Greenwood, Rebecca . i
, 1
4..S. / 1047 1
R-309-08 Cry
lir Tontnionuitaltil of itiaggarilugetts .
6 '1 1347 ': F130
90
8
2.r
No
OFFICIAL DISPOSITION, REMOVAL OR TRANSPORTATION PERMIT , DISPOSITION, REMOVAL AND
(Issued under the provisions of Chapter 114,Section 45,General Laws,ref.Ed.,as amended) , TRANSPORTATION PERMIT
Ma permit can by signed only by the igen,of the Board of Health(or in bored a where there Is no Bard of Health by the town clerlt)of the oily or
town in which the death mewed AFTER the F7LJNO and acceplence of a amIsfactory certificate of demi printed din permanent bloc*Ink. .
$PRINGF1ELD /
City/Town a • 3/ .20 ; SP tioslYs.....VeittlirlittlUNIAN"St „
95STATTREET6
tia Esstom,2(_r(1(__ , , , .. .
A satisfactory death certr hay' g been filedA ti.ro(
SPRINGFIELD, MA •••• • - --
, City/Town of lg.
RI naY:rdecedent
who died on/14 ( 4;3 Y7t,I V/ US War Veteran /.2/6/ Name of DecedentJc 44 9__.g..4.,,,,i,
date of eath
born on /-CI /907° • ,who resided at ! If a U.S. War Veteran,specify what war, organization,etc.
cp.e. .......444.21:;:;
, ENDORSEMENT
. ,
and who died of..A.e.yr, . . . . (To be filled in by cemetery or crematory official)
give immediate cause
Permission is hereby givéi for(check all ap op ' e boxes):
I hereby certify that the body accompanying this permit was
I I Removal C p. disposed of in accordance with its terms
r at
yDisposition t:All ‘1441-1)
(gip
I address of origi CliSpOSition
6,....ice'vrwity ale
zy eAf)b.''Y
. ;address of re'rnetery o latory Age-74,-
(Name of cemete or crematory) (City/10.1y: 044,,,i
I I Transportation to: on
name and address of immediate destination of remains
Permission is he by iven to: ',pc...I& Q1 Final Disposition
----
, ..
I1411"--/A , _ Certified by
ignature of u erintendent,cemetery or crematory)..0 /*/* /41- "
address of'facility .
Director If there is no officer in charge,fuiwral diivctor must sigil and return this stub.