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:  Minnie Butler

Place of Death  Butler, Clark, Wis.

Date of Death  March 6, 1948           W       F    77

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Cemetery

Location (City, town or country)    (State)

Clark, 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.

Raymond V. Izydorek, Thorp, Wis.

To dispose of said deceased as above stated.

                                             Signature  Lon E. Bogumill

Date  March 11, 1948          Address  Thorp, Clark

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried      on Mar 8, 1948   in  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.