HomeMy WebLinkAbout1939.01.I~m•m 11VS-6-1:i0\i-7-37
COMMONWEALTH OF PENNSYLVANIA
DE~'AI~T1l~Eli1T OF I~EAI.TI~
County, ~~//.
EUREAU OF VITAL STATISTICS
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Borough, `~... ~ BURIAL OR REMOVAL PERMIT
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or Date of Death GZ.~-cl..C1~ _._. IStj
City, _._ ~ ;
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Full Nrrrne, ~ ~Y~.. L ....._ __.._... ......Age, c~ ~J_~~i_.._. Sex, ....~d1.~ _ Color,
Disease Carrhing De .. ~~~ .......................... _ _
Place of Burial, ~2:~%~t~-.-(/~..~!/,~r~=j-rc~-, ~~r_z~..2.r... .............. _.
or
Rernovul to, _,~ ................ Via, .. ...
Undertaker ~~.G~~ ... ~(zi/I/ ........................... Address ~~-,~~~...... /2 .... ...........
A certificate of death having been filed in my office in accordance with the Laws of Pennsyh-ania, ]hereby authorize the /oz
of the body of said deceased person as stated above. i- ~:~ [Bona] or Removal]
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~ / I Registrar's name]
Dated _ ., ~{.,.... / °~ ...... ....... ..............19.~~"... District No. OZ~.~lJ!_ ....d./.........
Burial
When the
with a tr
s must be delivered by the undertaker to the sexton or other persons in charge of the burial ground or cemetery wh~~e burial takes place.
is to be shipped to a distant point requiring the service of a crommon carrier, in addition to a removal permit the body mast be accompanied
permit, containing the affidavit of the undertaker, which moat be attached to the box containing the body.
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