Huff, Edith FORM If H.D.C.,REV.
HEALTH DEPARTMENT
DISTRICT OF COLUMBIA
BURIAL PERMIT
Date issued �y
�f't, / , 19 --+"'*--- kilt d -/ a
No.
Name of deceased --
Place of death i o� _
Place of residence __ f'
-.---_— Date of death __ __, 1 4—Sex Color _.C.(,)__ Age __`A4__
Cause of deh i
Attending physicn - _ _- - --- ---- - ---- M.D.
Per ' ' n` s,he it .�yen for the removal oft r mains of the above-n ed person by under
taker • ,¢0 _ __ to for Interment
on --�- 62 - -, 19 - j f).7 i y i.
4'-`4ft4 ikvtl,"Lk k
OEORGE C. RUHLAHD, M. O., HEALTH OFFICER
IMPORTANT
This is a duplicate of the permit issued in this case, This duplicate is not to be returned to the Health Officer of the
District of Columbia, but must accompany the remains to their destination.
Y-2286
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