Saunders, Eliza •
Form 5.
rA W T® z®
r. ,BURIAL PERMI
/y7nA� 3
0 `P7ame oY Town j
+•' ��$i11a8et and County S ] �}
(Dated,)1 7 190
The Certificate of Death having been furnished to me, as required by the Laws of this State,permission
a is hereby given or the Burial of .. .. .. . . ... `� Age.....
E (City or o 'P)
0
who died at , in the County of... .
w
on. 150��,' the cause of death being
s Place of Burial... . ......... . . �� .-erl
,/,frLe...e")/ze
°" ITndertaker or person
s in charge of Hal, • (Signed by)... •
r ...
p‘e.../
Residence (Official title.)