Palmer, Hollis This°`Stub to be kept by person issuing Permit.
BURIAL PERMIT.
.1. Name of Deceased....
........I.........I..........t3rye,.. ., .
2. Place of Burial...J .. .`..... r ,
S Date and Place of Death.. ..... ..
4. Cause of Death.....
,6. 'Certified by.. ........ ... ...
..... ..............
6.. Undertaker..........4�.�A....