McMorrison This"$tub"to be kept by person issuing Permit.
BURIAL M T.-
.7. Name of Deceased. !E,. V
......A F;.4
R. Place of Burial..,
3. Date and Place of Death....
4. Cause of .................
' wr... ..... ......... .
6. Certife Y. .....................
.• ..
6. Undertaker....