STATE OF WISCONSIN

BURIAL PERMIT

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

Town of Butler Nov 29^th, 1919

                                                                                  (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  John Fred Warden

Who died at  Town of Butler             in the county of  Clark

On Nov 27^th, 1919                          the cause of death being  gun shot in the head

Place of burial:  Butler Cemetery

                                                                 (Signed by)  H. C. Conklin

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

H. C. Conklin

Date of internment: Nov 30, 1919                                   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.