Gray, Sidney This"Stub"to be k bg p on issuing Permit.
BURIAL PERMIT.
1. Name of Deceased t�i,.) . �..
.............. ......... .....................Ache,. .
2. Place of Burial..
8. Date and Place of Death.
1. Cause of Death.... ' ...
6. Certified by..... .e��. . .
.. ...., .H. D.
6. Undertaker.... rM►...V. c�