Loomis, Alfred This t°Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
J. Name of Deceased.. ... .. .... . . .
.......... ......... ......... .........���, . ..
2. Place of Burial...... ..
8. Date and Place of Death... ,f ..
.......... ...... ............. ...... .
..
!. Cause of Death. ..1 ge-
6 Certified by.... ..� .:.... :� cC��1..
............................... .............. .,.��fQ
6. Undertaker.....