Archer, Albert This"Stub"to be kept by person Issuing Permit
BURIAL PERMIT.
1. Name of Deceased.Q
................... ............. .........
2. Place of Burial.*. tiagp.
S. Date and Place of Death.
4. Cause of Death..... A... .............................
............................. .......................
,6. Certified by... .................
.................................................H. A
6. Undertaker...."'.CY."O.-L,