Odell, B This'4 Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
.1. Name of Deceased. r
AA
..... . ............. ..:..Age,. rr�.
2. Place of B'urtial.. W4 1.Ar►� rsrw� et.
. Dale land Place of Deaa... �..C"l..t ...
.� .....................
I. Cause of Death. ..... .....
....................
ti. ertifaed by "' ...... ....f. .
... .H. D.
6. Undertaker... .... �... . .....