Clements, Amelia This"S b"to"be- Vt'by person issuing Permit.
BURIAL PERMIT.
. .Name of Deceased..�'k:a t. `Cc..,.....
........flee,. .
L. Place of Burial..
S. Date and Place of Death. .1,�.f.41j-.
4. Cause of heath.. ��-�-
.. ^ �. ...
G, Certified by. i .a. ....
......... ......... .... ..... ................if D.
&. Undertaker...