HomeMy WebLinkAbout1942.01.corm nv~-oiovm--i-ni
COMMONWEALTH OF PENNSYLVANIA
~ DEPARTMENT OF HEALTH
• h BUREAU OF VITAL STATISTICS
Tou nship,~~G~,~-c+~ ~'jX. ~.. No ...................,~..G..l..r.....................
nr BURIAL OR REMOVAL PERMIT `/,,. /J
Ualc of D,vilh, ......_.... ...... .....................................19..
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City ................ti...~j............................ -
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Full Nance,.....J~Q,fi ~ .... ..... .... ...."~.......................... 4 ~~.. ...........Sex... ... ..Gr...e......Color,..~.~'L~I~Z .••.........
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Disease C'ausiag 1)ea`Jj,...' .... .... .... .......... .. ...... ............... ... ....... .........................................................................................................
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Place of Burial,_ .......... ........ ~ .. ... .....~...... .. .J~ ................................................................................._........................_
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Remoral ,...j ...................~........ ... ...~........ .............................~ ......I'ia,.........
Underfak~~~.'~~•~rf/~.~.ra•6~• . ....~~f!'G.~%~!ll...~.....~~~.~l~ddrexx,...v.~.ca~:e%2~C~~.........,c%:~.!%G!!~..' ............................__...........
A certificate of death having be~ ed in m}• office in accordance with the Laws of Peunsyl~+nia, I hereby authorize the..../..: ~ ...................'._.
of the body of said deceased person as Mated above. y:. ~ [~ai or--Removaq
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(Registrar's Hamel .~
Dated...........~~~GG!/~/ ~/......~/ ................................19~.~ / Di.vtrirt .\'o....~1.:.....1. .......'.....
Burial permits must he delivered by the undertaker to the sexton or other persons in charge of the burial ground or cemetery where burial takes place. When
the body is to be shipped to a distant point requiring the service o[ a common carrier, in addition to a removal permit the body must be accompanied with a transit
permit, containing the at3idavit of the undertaker, which must be attached to the box containing the body.
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