Baker, Lois 4/7
R. z' Toinntotuu ai#M of i g is arf UIt #h +- R-309-08 No.
No
OFFICIAL DISPOSITION, REMOVAL OR TRANSPORTATION PERMIT DISPOSITION, REMOVAL AND
(issued under the provisions 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 for in towns where throe Is no Board of Health by the town clerk)of the chy or
town In which the death occurred AFTER the FILING and acceptance of a sagefactory certificate of death,printed or typed In permanent black ink.
This section to be returned Immediately to the Issuing City/Town,properly
WAYLAND March 16 14 BOARD OF HEALTH
City/Town Date 20 to
A satisfactory death certificate having been filed for (Office issuing permit)
Lois W. Baker WAYLAND
a City/Town of
Full name of decedent
March 13, 7D14 — — — Name of Decedent Lois W. Baker
who died on US War Veteran
date of death
born on
August 23, 2014 ,who resided at If a U.S.War Veteran,specify what war,organizat
date of birth
106 Hyland Drive
Lake Luzer ne, NY 12846 ENDORSEMENT
and who died of (To be filled in by cemetery of crematory official)
give immediate cause
Permission is hereby given for(check all appropriate boxes): I hereby certify that the body accompanying this
I I Removal from: disposed of in accordance with its terms
name and address of original disposition a t Pi PiL ,� j kit if-'^f �,r0 '148!f-"9i1 0166
I I Disposition at: Ile.... . V.W.. .r@tmat.Qxy tti s..Que. T,xs lxy... 4`.� (Name of cemetery crematory) (C'ity/T'awd
name and address of cemetery or crematory '''j I
I I Transportation to: on 3- I /- t
name and address of immediate destination of remains
Permission is hereby given to: Final Disposition 1
Fagg,as Funeral Home
name of facility Certified byr .... '�.:�. ..
551 Mt. Auburn St. , Wat r t wn, 024 7 7,f ature of S e mender*cemetery or cremate
... .......... ....
a �s of � ty
t� If there is no officer in charge,funeral director must sign and