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:  John W. Kile

Place of Death  Marshfield  Wood, Wisconsin

Date of Death  12-27-1972             W.      Male     74

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

Location (City, town or country)    (State)

Thorp, 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.

Donald R. Izydorek  Thorp, Wisconsin

To dispose of said deceased as above stated.

                                             Signature  Edward ? Walters, M. D.

Date  12-27-1972                Address  Marshfield, Wisconsin

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried    on Dec 30, 1972   in  Town of Butler Cemetery

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.