Kaulfuss, Peter Form 11 H.D.C.-3M-4-30-27 R. 12977-27
Health Department of the District of Columbia
BURIAL PERMIT No3. 8:4..7.1
Name of Deceased.4sl .. .... ... .... .
I7lat6 of Death 1.9 192., „
White 6aierrcd-Male iftgle Married Widow Div-meed
5 Age: Years .O -' Months 3 Days g
Occupation....ki C� �c�44 yl
Deceased
.1
Birthplace Father
Mother
kDuration of Residence in this District /pl.. 3Pin�
� Place of Death � //� ' 0'�/G. 3
\ Place of Residence
\ Primary
\I\'‘ t
I u
Cause of Death
Immediate
Duration
Attending Physician M D.
C Permission is hereby given for the removal of the remains of the
l'
above-named person by UndertakeX4” GZZ (�
tq,W.-4�' .... . - . +'`'9,.. Cemetery for interment
on -
,3� .. Z 1927...
, M. D.
Health Officer.
IMPORTANT
This is a auplicate of the permit issued in this case. This
duplicate is not to be returned to the Health Officer of the District
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