STATE OF WISCONSIN

BURIAL PERMIT

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

Town of Butler, Dec 17, 1924

                                                                                  (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  Nathan Cecil Brown

Who died at  Town of Butler                in the county of  Clark

On Dec 15, 1924                      the cause of death being  Abcessfo

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: Dec 17, 1924

                                                                                           (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.