Wood, John E "t Stub"to be kept by person issuing Permit.
BURIAL PERMIT,
I Namelp.of Deceased..F. 4"
.t... ..............
6 ......_ . .. ..age, .
.2. Place of Burial. ...... ... .
8. Date and Place of Death... .4"-L.. �,�...,.
. Cause of Death. ....
5, Certified by.. .... ...
......................................................
6. Undertaker..y... . ....: .......... ...............