Bucksbee, Albert Form 6
'° BURIAL PERM T .
m. Name of TownePt::::2 • • .
. 1(Pillage) and County.
(Dated,) f" 190
The Certificate of Death havin b urn'she t me, as requi by the ws of this State,permis ' n
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a. is hereby given "or he Burial of Age r
o or P•3
es who died at the Countyo
N
E on.... 1901,• th xeeo.(f..a death being , ,Place of Burial... . ,.. i
0 •
n' Undertaker r person
' in;charge ofo Burial; '_
flResidence -r
L
(Official title.)