Gooly, Lorrine is �-
BURIALsuing'Permt.
This Stu PERMIT.
Name of Deceased. ' A` .
................Age,'
.�?..�...
. Place of xial <./`d....
s. Date and Place of Death..
...........
4. Cause of Death—
Certified by.• .. .. ••
... D.
G. undertaker.• .. � -----