HomeMy WebLinkAbout1950.03.H~'~-90012-150\i-4-4J ,;"m'-~-10
Place of Death COMMONWEALTH OF PENNSYLVANIA
co,~,~ty,-~.~_.. _ DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
Tow~iship, .....:.._.._.._.._....____ ,
or BURIAL OR REMOVAL PERMIT No . .............._...-':.._..._.._._......-.....
Borough ..........
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;,~; Date of Death, ~~~/1~......~11..r..19.6'
.. -... ~,
Full Name, _._ . -;~~.G~'.....~ ..... -• Sex, -/~'~~~-.~ ........ - Color, .... ~~......
Cause of Death, .G.- ~ .
Age ~ ~"
Place of Burial, ...._... t..... ....... .. .. .... .......... .-......................-.......__._.........._ .._..._.................
or
Re~nzoval to Via,
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.. ¢..-,'- . fL ;>,. ~ ..~- ~~~ ...Address, ,. ~ ..
A cel•tificate of dea having been filed in my office in accordance with the Laws of Pennsylvania, I hereby authorize
the _~;,~,_:.:~ss%~.~......- _ of. thy' body of said deceased person as stated above.
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A~ (BI' 1 [1' 71:111 -
Dated _ _. _. _. _ _ .-: _. ..y.. -;~- :~ 19.-..~ Address Ems- 6 .:~. ~ >~~ ~ s.,,,~ ~
This ]31n~ial prrmit nnl~l h~~ d,~lic,n~~l he (b~~ uud,~rhlk~~r to the official in rhar;.;,~ ..f thr burial ~;rnuud it e,~motery ~chere burial takes place. A1'hen
ih~ I ..Iv i~ i , In ~I i~ 1 ~ 1,~ Ji>i.nit ~ iii i~"~ iii ins tl ~ - .~~ior of :1 rani n~..n o;u~~I r. in :nhb~i~,n to a rlnv~~al p,~rm it the body must be accompanied
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't'his permit shall be returned by the cemetery to the Local Registrar within 30 days