This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  George M. Butler

Place of Death  Butler, Clark, Wisconsi

Date of Death  October 5, 1956   W(hite)  M(ale)    78

Cause of Death  Generalized Sclerosis

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

Location (City, town or country)    (State)

Clark, Wisconsin

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, Wisconsin

To dispose of said deceased as above stated.

                                             Signature  F. P. Neis

Date  October 7, 1956         Address  Thorp, Clark, Wis.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried    on Oct 7, 1956    in  Butler 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.