Reynolds, James •
1
FORM It H.D.C.,REV.
HEALTH DEPARTMENT
DISTRICT OF COLUMBIA
BURIAL PERMIT
Date issued
r>
Name of deceased 21 jr, i‘i
Place of death ' % �� -f' - ---‘41f,
'
Place of residence __ '(---
Date of death ' ' ,7` , 196fSex 4✓ _-- Color t-4_ Age _—
Cause of death 7,die/.f_ .-- ��G�`<tt
Attending physician cZ_v. I: '21J -lfi-- 1.4 M.D.
PemMa.-
leon is he y giv for the oval of the r ains of the above-named person by under-
take �_.l_ 1 _-�� _ to - -�!/-/ c(�-e for Interment
on .1 ` J G ". , 19 _e_1�' . �GL v'iCIiG�! y/
GEORGE'C. RUHLAND, M. D., 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.
P-2286