Sault, Louis This"Stub to be kept by person issuing Permit.
BURIAL PERMIT
1. Name of Deceased
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Sex ......... Age,. ----------------
2. Place of Burial---St- ----------------
3. Dale and Place of Death...-_
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4. Cause of Death.................---------- --------
5'. Certified by..........................
---------- ------------------------------------ -------------- Af. D.
6. Undertaker...; -9-U-4e.
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Blan Publisher,Albany, N. Y.
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E.�OuG.
Sold by C. E. HOUGHTA G.Law