Hillis This"$tub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of.deceased.......................................
.............. . .....».. ... .....Age,
2. Place of Burial.........................................
S. hate and Place of Death. ............................
f
4 Cawe of Death. ... ............... ..... ...
0. Oertified ...............................................
z...........M. D.
6. Undertaker............................... ..............