Brayton, George Tbis"Stub"to be kept by person Issuing Permit.
BURIAL PERMIT.
-1. .Name of Deceased.. ... d 4.0.�
... .I....... ...... .............. Age,. L?.
2. Place of Burial. �.
S. Date and Place o Death. f.
f
4. Cause of Death... .. x..e e.az¢J. 'Lft......
.... ..
.6. Certified by... '::A.. . . .....
. .
H. D.
.......................................................
6. Undertaker..