Tripp, Hermoni This a°Stub"to be kept by,person issuing Permit.
BURIAL PERMIT.
1. .Name of Dec�ased.�It✓1!w.4iY4-� . . .���r��..
.............. .................. ge,. .
2. Place of Burial. . .
S. Date and Place of Death. AAem...1':7 l.0..
4. Cause of Death..
ti. Certified fiy,. .x........ . ? 5•.
6. 'Undertaker.