Jenkins. Kenneth TA J V NEW T' 6,,L--R(0 Form 5.
-r..- 13 T_TRIAL PERMIT .
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CS t..,7 J
(Dated,) 198;r
...
17te Certificate of Death having been furnished to me, as re fired by the Laws of this State,permission
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a e
is hereby given for th Burial of.fe.,--,-,...42"ge D 414--,-0.... Age!
(City or To .)
o
who died at
, in the Count .0.-,1 .....
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n C 4.21 2— 190% the cause o death being. a.--7.4..ever:hmaN4:hr
g o
1 Place of Burial op-eze"....14-1ez-les.'
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c 1
Undertaker or person #
-4,41444nE-51.4n3- (Signed by)
charge of Burial, • * * *
7‘23—c.....--,,--- e--e.„.4_,...._.
33 Residence 4-364-tet-1--. A:24--
(Official title.)