Harris, Mildred H Ow BMW
O
.ar 13TTRIA-E P R R M I T' .
ofTown
Ali- iiqi; iiqi' 11111
CE'i III and County.t ��*- •�
.(Bated,}. " ;: ... :. =., 91 , '
The Certificate of Death having been furnished to me, as required by the Laws of this State permission
+. 2s hereby given r the Burial of. ........................Age.��
(City or o hip.)
who died at.. ... an the County of... ' , : : .
on.. . :. .. 1 the cause of doath+beang.. :»........
I . .. . F
Place ..........
of Burial.. .. » :: . .. � .
. .Undertaker or , �� � � {����
arc charge of rial, � . (Signed by).. ..i:. . ..... ..........
Residence.
tc►f�c�si t,4tie.�