Marr, Francis A This"Stub" to be kept by person issuing Permit.
BURIAL PERMIT
1. Name of Deceased— -------
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2. Place of Burial--- ------- ------ ------------
S. Date and Race of Death.... -'-
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4. Cause of Death......C... ----------------------------------- . .........
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-
5. Certified by...... ..... -------- --- -------------
-------------------------------------------------------- ..........M. D.
6. Undertaker... ..........................
Sold by C. E. HOUGHTALING,Law Blank Publisber,Albany, N. Y.