This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  August O. Audorff

Place of Death  Superior, Douglas, Wisconsin

Date of Death  October 9, 1967     White    Male    62

Cause of Death  DOA St. Mary’s Hospital

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Removal

Cemetery/Crematory

Butler

Location (City, town or country)    (State)

Neillsville, Clark Co., Wis.

A certificate of death having been filed as required by the laws of this state, permission is hereby given to Funeral Director or person acting as such.

LeSage Funeral Home, Superior, Wisconsin

To dispose of said deceased as above stated.

                                             Signature  E. G. Stack, Jr., M. D.

Date Oct 10, 1967               Address  Superior, Douglas

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried      on Oct 1967       in  Butlerville

Located at  Town of Butler              Signature  Arthur Morrison

(Sexton or Person in Charge)

This permit must be endorsed by the sexton (or by the Funeral Director where is no sexton) and permanently retained in the Sexton’s files.