Mondaux, Bertha This Stub to be kept by person issuing Permit.
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BURIAL PERMIT.
, : .Name of Deceased. A.J. ^..:"!':�t................
.. ......K? s�t:+�4-! ....Aye,./ +r 64
2. Place of Burial... ...... .
S. Date and Place of Death. ? .! ,
4. Cause of Death.... .' . ...............
6. Certified.a...
............... [[ ............ .M D.
6 Undertaker. ..1 . ...