Jackawski, Josephine This"Stub"to be kept by person uing Permit.
BURIAL PERMIT.
1. Name of Deceased... .. A
.............
2. Place of Burial...�r'Q... !. .......rt�...
8. Date and Place of aujm"� ,
. ,......... ;.. ,' 1 .. . ..........
...
Cause of Death. ...... .................
5. Certified hy. .t1...!... ...........
.................. ...................................1�1: D.
6. Uadertaker.. .....