Drisham, Lucy This 0°Stub"to be kept br person issuing Permit. '
BURIAL PERMIT.
i. Name of Deceased.
2. Place of Burial. ... ....... ......
S. Date and Place of
.. ............
Gause of Z? atla. .' ......�.......
... . .....
6. Certified
:112 D.
6. Undertaker.. ...... ... :.........