Phelps, Rosacran This"S�ub"to be k$pt by person issuing Permit
BURIAL PERMIT.
1. Name of Deceased........ ..l.... .......: ....... ......
2. Placs of Burial-
S. Da and PZace of Death.
4� Cause of Death.!
5Certi ed b � .. ...
i . .. .........N.. D.
VI
6. Undertaker. - ..
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