HomeMy WebLinkAbout1950.01.Ill'S-OOOP?-150'~f-I-48 ~•,-10
Place of Death COMMONWEALTH OF PENNSYLVANIA
cou,lty, ~ __ DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
Township . .......................-...... ... ~
or ` . ~ BURIAL OR REMOVAL PERMIT No . ..................................................
Borough, ~)1.:~:~::~,-~.::z..,:....._ --
or J Date of Death, ~ ' S
City . ....................._.../.........-- - _..... ........' ...------- --- ... -.............19........
Full Name, •-_ L ,~/i{ ~' ................ Sex, ~..~'~`-- ~ ~~.
Color, '~
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Cause of Death, . ~.:.-./a~!~t?-?w..R~~~. ................... ...~~ .............. __..._......::.............. --........-------.,....,....._...._............ Age, .'.-...........----•----..
Place of Burial ..~.-.... ~~~ ~=> .. ...._.......::- v-~~J -..:...... ........- - --- -- ..... -
-----..L_4-_... ....- `--- ..
Removal to, V' ~
~ ... ....
-- -.. ...... .................. ....... la, ..... ........... ..... ......... ~ ........ ....... ................
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Undertaker, ....-- ~~ ~ ~ -- ..._ Address, `~= "' ~ ..........---
A certificate of death having been filed in my office in accordance with the Laws of Pennsylvania, I hereby authorize
~, the .__._._:.. .__~._.._......_.. of the body of said deceased person as stated above.
[Burial or R~~mucal] ~' - -
[Registrar's nanrr,]
Dated ....:......:..:.._~_...... ~.. ~~ ................_................. ---~ -19....._. Address _...... ~:..! ,_..., . -:..:.---- ~ ~ __ ~ /~:>~..._......................_.................
This Burial permit must he delivered b}- the undertaker to the of£tciu] in charge of the burial ground on cemetery where burial takes place. ~\•hen
ibe body is to be shipped to a di=tart Point requiring the sere ice of a cmnrnun carrier, in addition to a removal permit the body must be accompanied
with x transit permit, containing the affidavit of the undertaker, which must be attached to the box containing the Lod}~.
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This permit shall be returned by the cemetery to the Local Registrar within 30 days