Bellair, Malina Corro This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
a
1. Name of Deceased.0 .e �. . .t c...........
. .. ..ye,. d
2 Place of Burial . .
S. Date and Plats;of.17eath..
4¢ Cause of.Death.... ,
................................ ... .................
� o
,6. Certified
H. D.
ti. Undertake .... .