HomeMy WebLinkAbout1948.01.1IF5-?0013-15051-1-4d ':~, f--.~-10
Place Af Death COMMONWEALTH OF PENNSYLVANIA
County,L~~c~ZGG~L~r~ DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
Township . ..... ........ . ..
or BURIAL OR REMOVAL PERMIT No.
Borough, .... - L -- - --
or Date of Death, __ ........__ ...---- - ........ i~..~'1~19~~
City, -- - - ----- ...._....
Full Name, ~. .... ~..... .... ~~.... ......... . ........Se ...,//iiG<C~...... ......... ... Color, ....~J.FI/ ..._...........
Cause of Death, ... .. ... ~ .. ".... .- ............~..~~~.~ ... . ................ ......... . . .... Age, !T.~..7--.......
Place of Burial, .... ~ ~ ~-
or ~~
ff .......... - - .. .................. .
Rea~coval to~ ..._ ...... --- ............... ..... .. Via, ---- ......................~/~4~LL~c....... - .......... - ......_........---
' -_ -' ~°r,. ,, „ . ..
~ `~~~ ~ Address,
E7n~er`takc~l.. ~.~~... ~~ ..U....... _ ..... ................._..._.._.... ~~........----- .........-- ........._........._...........................
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;A certificate of death having been filed in my ce in accordance the aws of Penn lvania, hereby authorize
;' .~,-..-- ,.:::-fl - _ _ . -.. _ of the body of said deceased person as e ab ve.
the
~ Itinial -w~--li.-rrrncTl7
.. ........................T -................
...
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Dated _ ........ ..... - - ......._....~`~'E~''.7L~.~..19:`~ Address'' 11 /l% .G~- - - - ----...- --------~- ---
This Burial permit. must be delivered by the/~Lndertaker to the official in charKe of the burial ground or cemetery where burial takes place. A'hcn
the burls is to be shipped to a distant point requiring; the service of a common carrier, in addition to a removal permit the body must be accompanied
kith a transit permit. containing; the affidavit of the undertaker, which must be attached to the boy containing; the body.
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This permit shall be returned by the cemetery to the Local Registrar within 30 days