Brown, David Form Health 40-A /J1
W No. � 02 iis'r artUWI1t of Bratiff
�j/
x
`A
'" 02303 YAK AUG - 6 192,7
W 3---,.,'i 1 Z,,,,+-.L /7 Lo n les, Cal., 191
0 4124'.24----4,,,,7 "le,/4.419,;:
F 111fl1,.UAf is hereby given for the removal, the ashes of
%/mil/ "16years, % months, `days__
Race �vL , Sex , Place of Birth
J Die / 19..G_, Place of Death • l� T// L�
/se of Death��l�j l//� ,Psi 'an i
From ory to �� --
" _-_�
.A.".' / Deputy Registrar Health Commissioner and Registrar
l
P
<
s - -
s .