White, Mary A This"Stub"to be kept by Person issuing Permit.
BURIAL PERMIT.
I Name q f Deceased.... .
............................................... .
Place of BZcrial.....,�e � ..
.3 Date and Place of Death....
4. Cause of Death. .
5. Cert bed by... .. :2<;.. �", � ? o
............................
6. Undertaker.....