Barber, H This"Stub"to be kept by person issuing Permit
BURIAL PERMIT.
1. ......
Name of Deceased.... ..
..............................................Age,...7-
2. Place of Burial...
8. Date and Place of Death....
.......................
Cause of Dealh..-�Avj,.
..............................................................
6. 0erHfiedby--,j.&,5tj....
......................................................ff. A
6. Undertaker..
T