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:  Salome Gladys Ondal

Place of Death  Chippewa Falls, Wis.

Date of Death  February 17, 1973       White    Female     68

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

Location (City, town or country)    (State)

Clark County, 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.

Bill Plombon, Stanley, Wis.

To dispose of said deceased as above stated.

                                             Signature  Lou Puott (?), M. D.

Date Feb 23, 1973              Address  600 Bay St., Chippewa Falls, Wis.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  burried    on Feb 23, 1973   in  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.