STATE OF WISCONSIN

BURIAL PERMIT

Penalty for Burying Without a Permit, $20 - $200

Town of Butler Dec 4, 1925

                                                                                  (City, Township or Village)

A satisfactory certificate of death having been furnished to me, as required by the laws of this State, permission is hereby given for the burial of Alexander Buchanan

Who died at Town of Butler                            in the county of  Clark

On Dec 2^nd, 1925                                            the cause of death being  not given.

Place of burial:  Butler Cemetery

                                                                 (Signed by)  H. C. Conklin

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

Date of internment: Dec 4, 1925                                   Butler Cemetery

                                                                                           (Name of Cemetery)

This permit must be delivered to the keeper of the cemetery where the burial occurs, and should be endorsed by him and returned to the local registrar of his district.