Hovey, M Ernest This t0 Stub"to be kept by person issuing Permit.
BURIAL PERMIT.
1. Name of
..............................................Age,... � t'..
. Place of t32craaZ... 'Kam$-...: !.... R t
S. Date and Place of Death....- , A tg;.....
E4A,*7--
Jt. Cause of Death.. .. . .....
.............................
5, Certified by..... ...
............................. ........................M: D.
6. Undertaker.. ... .....