Abare, Margaret Tbis"stub"to be kept by person issuing Permit
BURIAL PERMIT.
I. Name cf Deceased... . . .. ... .. .....
......... .............. .Age,. ,
2. Place of Bzurial. ......
8. Date and Place of Death..................................9-f-
Cause of Death.. , .
. .. '. . .`. ..... .
5, Certified by.
.�:.
............ .....
B. Undertaker. e