This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  David N. Butler

Place of Death  Butler, Clark Co. Wis.

Date of Death Jan 19, 1950         W.     M.     79

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butler

Location (City, town or country)    (State)

Clark Co., 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.

R. V. Izydorek, Thorp, Wis.

To dispose of said deceased as above stated.

                                             Signature  N. P. Neis

Date Jan 20, 1950                Address  Thorp, Wis.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried     on Jan 23, 1950   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.