Bell, Anna Jane This"Stub"to be kept by person issuing Permit.
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BURIAL PERMIT.
1. Name of Deceased. ., _. . "�~ �!.......r..
...... ...........�3�e,.L?.fi
2. lace of
S. Date and Place of Death.. •7i
. . .,v .'...... .....
4. Cause of Death. �''.. .......
.............................. D.
6. *Undertakerk. '