Gwinup This"Stub,,to be kept by person issuing Permit.
BURIAL PERMIT.
-1. Name of Deceased... AV.V & .............
,..........Age,...........
. Place of Burial.... ..-Ld................,...,
. Date and Place of Death.. .....5.f......
4. Cause of Death...
..........
,
Certified bg.
......................................................M.. D.
6. Undertaker, „ ,, ,,,,,,, ,,,,,,, ....