Dury, Edna Form b, .
INMATE OF NEW YOWL
�3
BURIAL PERMIT
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VI
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(Dated,) `�'; " !7 190
The Certificate of Death having been furnished to me, as required by the Laws of this State,permission
is hereby given or t vial of ...Ca �,. . ... ...450. :....
c (City or p.
1 who died at .' , in the County of.... .... ..
ca
E on 19O the-cams of death being.. . . .f l:.. � :r y
t. Place of Burial... '�"'� "
CD
Undertaker or person
rin charge of Burial, (Signed ). w,... .. ....................
h Residence.. .. ?�---f.� e2�L .CC ' ..
(Official t1t3e.)''-