STATE OF WISCONSIN

BURIAL PERMIT

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

Wilson Nov 6, 1935

                                                                                  (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  Phoebe Groid (?) / Girard (?)

Who died at  Town of Wilson              in the county of  Clark

On Nov 3, 1935                                       the cause of death being  childbirth

Place of burial:  Butler, Wis.

                                                                 (Signed by)  illegible

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

S. Plombon

Date of internment: Nov 6, 1935

                                                                                           (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.