HomeMy WebLinkAbout1945.01.1fYS-3n0] ~3-1.T0AI-8-43
COMMONWEALTH OF PENNSYLVANIA
.. ,-,
oe: 'en io
County, .y~ ~~- DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS ~-r
Township, .............~f~. ``~'
No ..... . ........................................................
or BURIAL OR REMOVAL PERMIT
Borough, .................... ~
or .. ........................ Date of Death, ~~.._ _ 19/~--
City, - - '
~ ~ ~1 / ,
Full Name, . _:: , _ ~.... ..................1l...~. ~.e, / /6. c"~~~~ Sex, ..:// ,1..!.... Color, . _ i. [ ~ ~.
Disease Causing Death, .. ................ ... ................. .. ~ ~L:~...-r.., .... ................
t
Place of Buri¢l, _ _ ....:: .. ... ... ...... ............. _.. __ .. ... ........................................................................._...
or
..
Removal to, ~• -. / la, ~. /, .. C"i- ...... ...
__:
Undertaker, .... L... .--_ .~ "" :_.~..<.z. ~ ~.. `` ..~ __ .Address, _ ~.._:G-!l.~a-~-~a
A certificate df death having been filed in my office in accordance with the Laws of Pennsylvania, I hereby authorize
the _... ~x-r~~c~r~~'..... of the body of said deceased person as stated above.
Rui i.d m' Removal l Zj~
i [Rc~ist rar's name]
Dated ... ___._ _ ~:~ .../.i ,... _..__..... _.. 19.x' _ District No. ~ ~-~ '3
. ~ ~'l' ~ 1
~ n • L « n~ ~ r ~~ v~ F i wh•n l u ak s lac .
~ b L n o ~~ i r r r. n: in h.n *~ f h~. w ial r i n l o t o t nal t ~ e
Suriul rernul, moat. ~ dcliverid y the u dertaker to the sexton r 1 ~. ~ t, f t P
VA-h~u the hudv is to hr shipprd to a distant point requiring the service of a c unu~ai c,n~ii r. ui ,iddrtinn to a r~•muc.il Ii~~nnL ihe~hnd}~ mu.t be accrnnhani~d
kith a tr.msit p~rnnt, c ndainin~ the atNdavit of the undertaker, which mutt hc. +tt iched t~~ the boy con t.iinui,~ the 6~~~Ip.
--
b <
P A
O
'-+~ p
y
y
~' <0
co n
a
a
`\
(~
~ ' V.
n
P
~ ~
~o
ti
c-r
y
R