STATE OF WISCONSIN

BURIAL PERMIT

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

Thorp, Wis. May 18, 1932

                                                                                  (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  Dorothy Edith Shoemaker

Who died at Town of Butler             in the county of  Clark

On May 18, 1932                   the cause of death being  lack of vitality

Place of burial:  Butler Cemetery

                                                                 (Signed by)  Myrtle R. Smith

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

E. A. Shoemaker

Date of internment: May 18, 1932

                                                                                           (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.