This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Alvina Girard

Place of Death  Chippewa Falls, Chippewa Co., Wis.

Date of Death Nov 10, 1948    W      F    75

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Clark County

Location (City, town or country)    (State)

Clark, Wis.

A certificate of death having been filed as required by the laws of this state, permission is hereby given to Funeral Director or person acting as such.

Severyn Plombon, Stanley, Wis.

To dispose of said deceased as above stated.

                                             Signature  Albon ?. Overgard, M. D.

Date  November 23, 1948    Address  Stanley, Chippewa Co.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  Buried       on  1948     in  Cemetery

Located at  Town of Butler          Signature  Arthur Morrison

(Sexton or Person in Charge)

This permit must be endorsed by the sexton (or by the Funeral Director where is no sexton) and permanently retained in the Sexton’s files.