Van Duesen, Deborah M This b" to be kept by person issuing Permit.
BURIAL PERMIT
1. Name of _--------------------
_
— ---------- --- _ - - —
Sex -- A e . -------------
2. Place of Burial----
S. Date and Place of Death
-- --------- - —
4. Cause of Death._: .. - ------ ............
6. Certified by s - . --
----- - -----------_.M. D.
6. Undertaker__
Sold by C. E. HOUGHTALING.,Law Blank Pubiisber,Albany, N. Y.