Clements, Eva Jane This"stub"to be ke t b P BPerson iasufnRPernait
BURIAL PERMIT.
1. .1Val o Deceased.,,+ rr�-. A
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Placa of Burial.... :,
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` S. Date and Place of Death....
4. Cause of Death..
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6- Certified 8 : �,rr//
6. Undertaker .. ...: .' D.