Wood, Gene This,,Stub"to be kept by person issninP�Permit "
BURIAL PERMIT.
1. Name of Deceased�.�-.)
... ............. ............................Ache,.
2. Place of
Burial... l .
S. Date and Place of Death.. 1 .
1. Cause of Death. f
f. Certified by.
.......................................................M D.
6. Undertaker... .+ -� --