Riley, Peter This"Stab"to be kept by person twuinx Permit.
BURIAL FERMI
1. .Name of Deceased.
..f l9es .
i
B. Place,of Burial.. ...�i�....
S. Date and.Place of.Death... .t.:t�..�VIA
4. Cause of Deana. !' `. :...
b. Certified
................................................. 1K Il.
6. Undertaker.... ..