Heath, Sidney This 11 Stub I"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased..S44vm I. . 4AAAt-
..............................................
2. Plam,of Burial...
8. Date and Place of Death--Q4�.x.
..............................W............
4. Cause of Death...
............................
6. Certified by.. .1.........
.I......................... .........H. D.
6. Undertaker..'RAkv.%-.Aj........I........'