Lennox This 11 Stub"to be kept by person Issuing Permit.
BURIAL PERMIT.
1. Name of Deceased.
..............
..........I.....................
2. Plac-, of, Burial..ea.At.".�. .�....
<T
S. Date and Place of Deaa---V-v*-cr---,- ..........
........... . ...........
4. Cause of Death..... ...........
.............................. ..........................
6. Certified bA
M. DL
6. Undertaker- .......... ..