This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Ida May Butler

Place of Death  Butler, Clark, Wis.

Date of Death Jan 21, 1953          White     Female    89

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butler

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, Wis.

To dispose of said deceased as above stated.

                                             Signature  F. P. Neis

Date Jan 24, 1953               Address  Thorp, Clark

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried     on Jan 25, 1953    in  Butler

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.