/aS'S'g 
Physician! are reminded of the importance of Ailing out these CertiAcates with accuracy. 
They are the Basis of the Mortuary Statistics of the City. 
CEMETERY CERTIFICATE. 
(This Certificate must be fully and accurately filled out.) 
^ame . (White.) (Colored.) 
2)ate ^eattv^.... 
^^tace 
<2^laoe 2)eath^ 2Pa . ■St'l'ieet^ 
ST. LOUIS, MO. 
Mg^e^ .. gea'ii)^^ ... dai/A^ 
(SINGLE.) (MARRIED.) (WIDOWER.) (WIDOW.) Cross out the ^ords uot reciulred. 
^auAe S^eatti^ _ .. . .. 
1 CERTIFY that 1 attended the person above named, in _ _ last 
illness, who died of the disease stated, oi^^the date above named. 
M. (Z). 
{Address,) 
2^i(ioe MaUaij 
U nder taker. 
Office Healtb Department, 
Missouri botan'cai 
GEOR(5E EUGELMAW 
