Brucceaginse, Chas ThJO Stub"to be kept by P-1--issuing Permit
BURIAL PERMIT.
Name of Deceased..,..•
..... ............Aye,. ..
2. Place of Burial.; :'
S. Date and Place of Death.
...... .....................
4. Cause of Death.. ...........
.............
•
,i. Certified by..
... .............................................. .M D.
t r : k'.•
6. Undertaker �:<