Haviland, Joseph This"Stub"to be kept by person ruing Permit,
BURIAL PERMIT.
1 Name of Deceased..... . ................
2 Place of Burial, . ::.: :..... .
8 .gate and Place of Death...l. .�.�.j 2
...... . .. . .......... ............ ............
4.. Cause of Death...... . ........ ....
S. Certified
........... ........ .. .... .1Ci II.
6. Undertaker...