Stewart This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT,
I. Name of Deceased...
...............Age,.2�"
2 Place of Burial...lAe. . ..
8. Date and Place of Death-t-1
.................. ,...... `�. ..... .' .... .
4 Cause of Death.............
6. Certified by.... ..... ...... ........ ...
.;.......... ........................M U:
6. Undertaker. . "