STATE OF WISCONSIN

BURIAL PERMIT

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

Eau Claire 12 - 19, 1930

                                                                                  (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  Laurel E. Schoemaker

Who died at  Eau Claire                                    in the county of 

On                                                the cause of death being  congenital heart disease,

Cerebral hemorhage

Place of burial:  Town of Butler - Thorp

                                                                 (Signed by)  L. H. Flynn

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

E. A. Shoemaker, father

Date of internment:  12 - 20 - 1930                                   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.