Minard, Wood This`°Stub"t6 be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased.7 v-x4.-%.1rl .,........
..................4ge,. .`!�...
2. Place of .Burial.. ..
! 4
S. Date and Place of Death..
4. Cause of Death... # --... v. '
6. Certified by... G... ........ .. ....
........ ..... . . ......................H. D.
6. Undertaker. .., ....