STATE OF WISCONSIN

BURIAL PERMIT

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

Clark Co., Butler Township 3/7, 1923

                                                                                  (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 Karl Audorff

Who died at Town of Butler                            in the county of  Clark

On Mar 7, 1923                                         the cause of death being  senile debility

Place of burial:  Butler Cemetery

                                                                 (Signed by)  H. C. Conklin

                                                                    (Registrar, Deputy or Sub-Registrar)

                                                                                      H. C. Conklin

Undertaker or person in charge                                      (Sexton)

Howard Cummings, H. C. Conklin

Date of internment:  Mch 9, 1923                                 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.