Stevens, Edward This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased. :Rr1 !�4!.,�e �5-serfs
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Place of Burtal... 1. ^�
8. Date and Place of Deatli...5#7. ...;nl...
4 Cause of Death.. ,.
.
a. Certified �y.. . �.. ` . .........
...................................................... U.
$. Undertaker........ ....... .....................�......