Unknown To be Retained by Cemetery Company
No. of Permit, I V qz./ ,Date of D th, .
Name of Deceased, sili:644,44 -42lZ
Place of Death, 0.6.4..,-.4... ../.... A.:
Cause of Death., .. .e34ettr<Atd444-11--#2...4(
Date of ssue, ..:
,ZPic.tpaocal Registrar.
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