Mead, Walter M&"Stub'"to kept by person issuing Permit
BURIAL PERMIT.
Z Name of Deceased....
............................................... ye,. . .
Q. Place of Burial. 64,. L.
8. Date and Place of Death...
............. I"V
4. Cause of Death.. 4k . .ra................
6. Certified by... . ..�r :..............
......................................(.................M Lt
6. Undertaker..t...KL.�... .. .✓. 1�, .