Ensegn, Albert V This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. .Name of Deceased... ...
.............................................. ge,.0..
2, Placs of Burial... : . aaa ...�-�4.+'-R-fir,.....,
S. Date and Place of Death....341..S.#f....
lt.l..2..�.,. ..A I ........,
4. Cause of
5. Certified by.... . ,. ., ef
...........................................f. D.
6. ZTndertaker.,..... ............ ..