VanHeusen, Leonard This"Stub"to b ept by Person Issuing Permit`
BURIAL PERMIT.
I .Name of Deceased......
2. Place of Burial.
8. .Date and Place of Beath... ..
�.� .,. .............
4. Cause of Death et
-
.........
6. Cerlt6ed by, ...... -- -. .....
. ,�1` D.
... .......................
6. I�ndertaker. r
y