Bennett, Lauretta B This Stub"to be kept by person issuing Permit,
BURIAL PERMIT.
Z, Name of.Deceased. ,
.. ......... ............... .........Age,.IZ.Z +
2 Place of .Burial..... =- r `` J ... ....,
S. Date and Place of Death.. '�--Gl
........................
4. Cause of Death...".
6. Certified by...............................................
......................M.. D.
6. Undertaker.... ..... ................ ............