Elms, Roxanna C ryy p y�y, kept
�# Permit
}y {2�"FSt' i�U Ug LG�L flg person n .G 8� �W
BURIAL` PERMIT,
I Name of Deceased.)G�&%ixe.11 .4t ........
. ... ..... ..49eyg .
Place of Burial. • .
8. Date and Place of Death... ' +-..�.Y/
Ole—
I. Cause of Death.- a e`f, . :......
....- .... ........
6.
......................................................Z. D.
6. Undertaker,.. .. ... .. `.......... �