STATE OF WISCONSIN

BURIAL PERMIT

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

Butler, Dec 31, 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  Verbena Belle Rasby (Reasby?)

Who died at  Butler                            in the county of  Clark

On Dec 28, 1935                            the cause of death being  hyperatensive (?) cardio

Vascular disease. Cerebral thrombosis

Place of burial:  Butler Cemetery

                                                                 (Signed by)  Myrtle R. Smith

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

Date of internment: 

                                                                                           (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.