Hovey, Clayton This"Stub"to be kept by person Issuing Permit
BURIAL PERMIT.
1. Name of Deceased......:.... . �� ..
OF
.... .. ..............Ae,. r4.
2 Place of Burial.. . ..JJ(A, `-!::^-�-:.
S. .Date and Place of.Death.. �..C ..
. .
1. cause of.Death...11.. ..
6. Certified `+.. ..
.....1......... ......... ....... ............H. D.