Gilmour, Mary i
A.309-00 1 IN Tommnnwrttltli of ffitto, ttrlpiortto R-3� Lift)
No
OFFICIAL DISPOSITION, REMOVAL OR TRANSPORTATION PERMIT DISPOSITION, REMOVAL AND
(issued under the provisions of Chapter lee,section 45.General laws,Ter.Ed.,as amended) TRANSPORTATION PERMIT
This permit can be signed only by the agent of the Board of Hasid,for in towns where there I.no Board of Hearth by the town clerk)of the city or
town in which the death occurred AFTER the FILING and acceptence of a satisfactory certificate of death,printed a typed In permanent black ink.
This section to be returned immediately to the Issuing City/Town,properly endorsed
City/Town �r.+�/1,.... .. Datev ' j
20 to ...1 t, —634. '' +t`n S1
ftlificc`issuing rorrnitl
A satisfactory death certificate having ben filed for
414, yc,f1. /14"`' R City/Town of G� 6CLiIl14/ Mass
Full name of decedent
7)LC " O' Name of Decedent
who died on US War Veteran
date of death
(?C I �' If a U.S.War Veteran,specify what war,organization,etc.
born on J ,who resided�� ) at
r� date of birth
/ /rS /0/4 °/l.' /G-
(A (A-Xi 114// >'f(fc- 'j J/1 4 ENDORSEMENT
and who died of 1'fiktit'ev akt L' fr-a+4' Y �
f•" f dt
(To be tilled 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
i I Removal from: disposed of in accordance with its terms
name and address of original disposition
�.' ) I t+*4�d
/l✓[��l!/C % C/�C f! -9%u-',I t,� 0t/t.C s'I4 V /7 �i// at 11 i Es t
lief Disposition at. (Name of cemetery or crematory) tC4/Toc�nl
name and address of cemetery or crematory �,`
I I Transportation to: on Asy jj ti lr: 3
name and address of immediate destination of remains �}
Permission is hereby given to: �/ i Final Disposition `!!l..t.,...
64/(c i u"' /(�4'C,"4 e //f "t tiI
/ G nametf}ility i4e� Certified by
!_c ' ,f4A, i1, ��/lily,,��i i' i f.f (Signatu of perintendent,cemetery or creme
((l7 ,•'+/�y'�� ��Q address1` of facility �,,y� ,,
1 1 \ltZAJ:L%._.`I ..r -Lirk./_t' If these is no officer in charge,fmmrat director mu,l.,igu