HomeMy WebLinkAbout1939.02.L'orm II~'5-6-160Jt-7-37
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COMMONWEALTH OF PENNSYLVANIA
county ,~~r~~~~,.,d ............. Y3 E P A R T 1VI E let 'Y' ®F I~ E A L 'I' ~'i
• BUREAU OF VITAL STATISTICS
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BURIAL OR REMOb%AL PERMIT
Borough, ...........
or Date of Death . .. ... .... ...1..4c~~....~_. __ _ _. 1909
City, ...... .. .
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Full lVlID7P 72.~4~z DYI',~~-!~~ ~/../.. .........flge. ~az~,n-r~r~.....~S~ex, ...,~j ~Qe......._. ~Cjo'or, G~~
Disease Causing Delt~jt. .,vaz"/lost<,7o~p.c~'r~s~!.e'.(.e~"•~-~ . 'r ~31~~e[~/!.- ~-.-~ :~`}o ~..,<7........
Place o f Burial, . ~/.~/_ ... ~... ...Gyi~z.G!C....~J,c./ ~.dJ-~c~,......_.. l/ t
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or
Removal to, .................. ....................... ......... l~ia, ,
L'nrlertaker, ~~-cf~~.~ti...~~~1'.Gx~t~ ...... .... ......................... Address, c...~~tut~v.. ~'....._t ~~,.._ _
A certificate of death havinh been filed in my office in accordance with the Laws of Pennsylvania, I hereby authorize the /,oy~c.~l
of the body of said deceased person as stated above. ~- ~. [I3ur,a1 or Ren,o~nl]
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~ ~-- [Registrar's name] ~ ~
Dated ... ... ~,....._C~... ~~ I9.c.39 District .1Vo ~~_-~/~.....~~
I3urial permits must be delivered 6y the undertaker to the sexton or other persons in charge of the brn~ial ~-nnmd or cemetr~ry o~h•~~e hurial takes place.
'. ~Cfirn the body- is to he shipped to a distant point requiring the so n-i re of a common carrier, in addition to a remnva] permit the ho~l}' rm!st Lc accoml~ani+~d
with a tramit permit, containing the affidavit of the undertaker, «-hich moat be attached to the box cnntsininl; the body-.
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