Lilly, Carlis H This`°stub"to be kept by person tensing Pe—It
BURIAL PERMIT.
1. Name of Deceased...�4 .. .. .......
............. .........I........ ....., age,./. .. .
2. Place of Burial.. `
r
S. Date and Place of Death...
fQ! ....... .....� ........................
4. Came of Death..... ...................
6. Certified by......
�A..... .........¢... D.
6. Undertaker.......,. . . ..✓.t«!