Wilcox, Sophia A This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased.
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2 Place of.Burial... �r—,
S. Date and Place of.Death..
4. Cause cf Death+f" `° •.'"( ........ ..
6. Certified
.......... I),
6. FTnderttrker... . .. . .,.. ....... .