1 Place of Death

County:  Clark

Township:  Butler

Village: 

City: 

STATE OF WISCONSIN

Department of Health - Bureau of Vital Statistics

Original Certificate of Death

                                                Registered No: 

2 FULL NAME:  Wm C. Butler

Personal and Statistical Particulars

Medical Certificate of Death

3 Sex

M

4 Color

W

5 S/M/W/D

Married

16 Date of Death (M/D/Y)

Oct 7, 1935

6 Date of Birth (M/D/Y)

Nov 4, 1863

17 I HERBY CERTIFY, That I attended deceased from

that I saw him     alive  on Sep 29, 1935

and that death occurred on the date above, at

The cause of death was as follows:

Senile debility

Signed:  B. A. Cole

Date:  Thorp, Wis

7 Age (Yrs/Mos/Ds/Hrs/Min)

71/11/3

8 Occupation

Farmer

9 Birthplace

Nelson, Wis.

10 Name of Father

Geo. A. Butler

11 Birthplace of Father

PA

18 Length of Residence (Hospitals, etc.)

12 Maiden Name of Mother

Nancy Musch

13 Birthplace of Mother

PA

14 The above is true to the best of my knowledge

Informant:  Minnie Butler

Address:  R3 Thorp, Wis

19 Place of burial or removal

Butler Cemetery

Date

Oct 9, 1935

15  File date - Registrar

20 Undertaker

John G. Bogumil

Address

Thorp