STATE OF WISCONSIN

BURIAL PERMIT

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

11 - 4, 1927

                                                                                  (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  Isaac Homer Butler

Who died at  Sacred Heart Hosp.            in the county of  Eau Claire

On  10 - 31, 1927                               the cause of death being  double lobar? pneumonia

Place of burial:  Thorp, Wis.

                                                                 (Signed by)  J. F. Farr

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

John G. Bogumill

Date of internment:  11 - 2, 1927                                Town of Butler

                                                                                           (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.