Williams, Ida Form 5
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BTTRIAL PERMIT .
7,2
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-' Name of Town 57riz(;(43,
� � .... .
(Village) and County.� ,
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(Dated,
.t(f 19Q?,
The Certificate of Death havin ee furnish to me required ' he Laws of this State, rmissi n
C
o- is hereby given Tort Burial of.. ® i' A . tK
go (Cityor A
• who die' at .. ... in the County of
E on....�! • *lk. 1✓0�• the /use of death bei ..
E P of Burial' ' ,
• Undertaker or person'i ..
ain charge of Burial, (Signed by). .
h Residence i� C'4
(Official title.)