Budabea, David This Stub to be kept by person issuing permit.
BURIAL PERMIT.
1. Name of Deceased. ..I! � r.
....... ............................. .Age,.
2. Place of Burial.
'.' Date acid Place of D th..
¢ Caus of Death......... ....<..
- ., .. .
y 5. Certified by. .. . .
#
ZZ
, �. ...6. Undertake