Reynolds, Sadie AAA AA.0
This"Stub"to be kept by,person issuing Permit,
BURIAL PERMIT.
1. Name of Deceased-S01.t. ... . .
...............:.....................Age . - .
2. Place of Burial..4fV.. ..
S. Date and Place of Death........
......., ............. .:r...... ..1..?`-'...........
4. Cause of Beath... ° ..
...... ...�, ...... , .....................
6. Certified by...�--' ......... .....: '�:''
................................
s
6. Undertaker. .................