Johnson, Joseph This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased.. �'t...
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2. Place of Burial.. ...D J��•.... �
8. Date and Place of Death....
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. Cause of.ZDeath. M..fEP -
T ..6. Certified by....... ... '.... ........ e,.
...................................................... U.
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6. Undertaker.. ."'. :...... � .... ..
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