This permit must accompany remains to destination

Bureau of Vital Statistics               Wisconsin State Board of Health and Social Services

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Harriet Kuehl

Place of Death  Thorp     Clark     Wis.

Date of Death  5-28-1974               White          Female         72

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butler

Location (City, town or country)    (State)

Rural Thorp

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.

Don Izydorek, Thorp, Wis.

To dispose of said deceased as above stated.

                                             Signature  Russell Mead

Date  5-31-1974                  Address  Thorp, Wis.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried     on May 31, 1974     in  Butler

Located at  Rural Thorp, Wis.       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.