Leroux, Mary This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT,
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1. .Name of Deceased.. ...s?c...,
.............
R. Place of Burial. . s� ,
S. Date and Place of Death... ....r ....��....
...................
4, Caussce,of Death. c.�
f
Certified by, x. ..... x«.......
........................... .. ................f A
6. Undertaker.. �. ..