HomeMy WebLinkAbout1947.01.11 ~'1-•?001°_-150\1-3-7fi ~ ~~,;~n•-10
Place Death COMMONWEALTH OF PENNSYLVANIA
County,~,~~'1~~~~' DEPARTMENT OF HEALTH
~~~~ ~~ BUREAU OF VITAL STATISTICS
Township, 0~~~;~'%f.CC...~~ No
or BURIAL OR REMOVAL PERMIT
Borough, ............_ -_.... - --
or Date of Dea~h,
City. _..._.. _..._ ......................
r -
Full Name, :' . ~ .~/.. ~~ Sex, { ..... . ....... ....... ..... ---... - ----
Cause of Death, ....~y~~/ .... ... .......................
Place [of Burial, .' .L ~ L....~~.'..~~ ..................
Removal to, Cl ~ ... ........ _ ....................................Via, .........._.. ,_ ~~
- .......
Undertaker,.. _~ . ~,_~~;:~ .-.~f~~!/' t~s~- . _....._....._.......Address, .-.Z~~
~... -
A cer~ ate of.d thl having been file In my office in accordance with the L
the .. _.... .... of the body f said deceased person as state~bo~
Address
......-..- Age, ~f~.-..~---•
Pennsyhwania, I la~by authorize
_-. ~,
~ ~- ~ .,
...
ame
mit must bo drlivca~~~d 65' ih~~ undertaA~~r to the official in char~;i~ o't---fhe burial 1,*ruuncf or cemetery where burial takes place. when
Lc shipped t6 a distant pninl royuiriu~ the service of a c<nn num carrier, in addition to a removal permit the body must be accompanied
permit. cnntainin~ the :dtida cit of the undertaker, ~chich must Le attached to the Los con[ainink the body.
~, Dated ..
rh15 Ijgll'la
the Ludy i
a~ith a~ tra
I
y
P
This permit shall be returned by the cemetery to the Local Registrar within 30 days