Scrnkwolt, Sophia This"stub"to be kept by person issuing Permit
BURIAL PERMIT.
1. .Name of Deceased.) .. . ........_ ................
..4ge,.. .
.2. Place of burial. "th �lz
.
S. Date and Place of .......
4. Cause of Death.J
......... .Y ap
....
S. CertifiecZ by. ... .. . ..............
6. Undertaker....