Derm, Julia This"Stab" o be keP g Person issuing Fermi#~
`' 3URIA.L PERMIT.
�. Name of Deceased.. "
...........Aye,7
2. Place of Burial. 7.• �. ,
. Date and Place of Beath...
¢. Cause of Death.. ,4�� `"�'
6. Certified by. .
..... ........... ..........................172 D.
6. Undertaker. '�