Whittimore, Lydia � I
This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
I. Name of Deceased.-^ dt .[. ....
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2. Place of Burial—AV. �n �rYL ...
S. Date and Place of Death..�.��1/..�,�"
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1. Cause of Deatli..
.6.UCertified by. . ctr+. s� �,....... .�
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6. Undertaker..