Crannell This"Stub"to be kept by person issuing Permit.
BURIAL PERMIT,
1. Name of.Deceased....... ,...!:'�rS
... ,... .......age,-�..._..
2 Placs of L'zcrial. ..
S. Date and Place of.Death. .............. .............
J. Cause of Death........ ..... .... ......................
............ ..... . ........
6. Certified by. . ...........
.. ........H. D.
6. Wiertaker. :�