Jenkins, Kenneth O Ills 11 Stub"to be kept by person issuing Permit
BURIAL PERMIT.
1. Name of Deceased-A& .............
. ..............Aye,.O,�
A
2. Place of Burial....
S. Date and Place of Death..0a..
4. Cause qfDeatA--Z ..........
..............................................
6. Certified by...C46 4,_BV!u.40&...
.....17.
......................................................H. D.
6. .Undertaker.Jhtl' '�-