STATE OF WISCONSIN

BURIAL PERMIT

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

Thorp, Wis. Dec 9, 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  Henderson twins

Who died at  Butler, R3, Thorp, Wis   in the county of  Clark

On Dec 8, 1932                                 the cause of death being  still born

Place of burial:  Butler Cemetery

                                                                 (Signed by)  Myrtle R. Smith

                                                                    (Registrar, Deputy or Sub-Registrar)

                                                                               Roy R. Reineke

Undertaker or person in charge                                      (Sexton)

Date of internment: 

                                                                                           (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.