Akins, Jane This 04 Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of Deceased..
........................I.....................Age,..., ,....
2. Place of Burial..
8. Date and Place of Death.. ..'z,.....
1. Cause of Deaths .. . ..........
6. Certified by.. �:.::.... ....................
...............I............................. .......X D.
6. Undertaker... . •.... ....