HomeMy WebLinkAbout1946.02.FIB'S-?001?-I50)I-3-da -10
i ~ COMMONWEALTH OF PENNSYLVANIA
j ,~~ DEPARTMENT OF HEALTH
County, `~
BUREAU OF VITAL STATISTICS
...............................................
~ Township, ~ `
or o. - _ __ ___ . r . ~ ...................................
Borough, ._.._.._ ........................................... BURIAL OR REMOVAL PERMIT -~
or Date of Death, ...._ __.~ .............................._~........._~.......~/..._..19
i City, __. _. ....... ....._
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Full Name, ,. ~-t!~~ ... `.r~" .:........ ................. ............. Age, 3~~` Sex, .....~~~~".......... _ Color,
li Disease Causing I}~th, ...... ~ ..................................-~......./..may..... ~ __ __
Place of Burial,~..;?y4~/ 4_ ................... .. ...-....-( /~~..~rit!~f~~ .... __.
or
~~~
RemQval~ ~ _..... _ ,,~... ...... .. .:. Via, _ . ...
U~zdertaltf ;~!',~~~ ._. ~s~~z ~'~..../l-"... ~~ -__Address, .~~~2~4`~~l,~i,.~/~-(r _ .
A tifi'c-ate 9f death having .been filed in my~6 e in accordance whir-the Laws of Pennsylvania, hheroby authorize
the ...~r~~'-~~? of the body of said deceased person as stated above, ~
[Burial mr-Iir+aara~tl ~ ,,.
._......
. ~ .. _._... [Regitit~ pr's nanx ] _..
.................
Dated .. ~G.~l.~ t=G~,Li _. _ y ~c ........... ... 19,x'. ~:: District No. ..~. -.~?.r...- fir..
Burial permits must be delivered Ly the undertaker to the sexton or other per,:ons liar vharge of the burial !~•ouml or cemetery where burial takes place.
1~"hen the brdy is to b.• shipped to a distant point requiring the service of a conmrou carrier, in addition to a renun~al permit the body must be accompanied
rcith a transit permit, cuntainiug the aftldavit o4 the undertaker, which must be attached to the boy r•nntainin~ the body.
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