Gwinup, Helen A This"Stub"to be kept by Person issuing Permit.
BURIAL PERMIT,
j. Name of Deceased. •L- -!:A�.......
.Age,. :'
2. Place of Burial.... -t .. ''Al'"
. Date and Place of Death. .•1•.•rk
I. .r. , ... ...
� Cause of.Death. .................... ...
Certified by... _. `: � t � f...
ail. D.
6. Undertaker. . '�