Potter, Clark This"Stab"to e kept by person Ssau ng Permit.
BURIAL PERMIT.,
1. .Name of Deceased'. .. .
.... ......... ....................Age,.... l 7
2. Place of Burial....cir5-*���.
S. Date and Place of Death..1 -! ..z 3, !fir ram.
.... .vim r ...... . .................. .
4. Cause of Death..
.............rt.,......................................
,....
6. Certified b2 e<
............... ..f D.
6 Undertaker. ......... ..................
u.