O'Brien, Oliva M t 21
This" tub"to W kept by person issuing Permit.
BURIAL PERMIT.
7 Name of Deceased. 7,4'& ,)• F), .
. ..............49e,——
�J c
2. Place of Burial.. a.au.. . .
S. Date and Place of Death..
4. Oduse of.death... ....
Rio' Certified by.:. . .. �.. .�..
......................................................ff. D.
G Undertaker. . . ........ . `. ,.