This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Mick Girard

Place of Death  Stanley, Chippewa, Wis.

Date of Death Nov 12, 1950                  W                   M           54

Cause of Death 

(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.

Severyn Plombon, Stanley, Wis.

To dispose of said deceased as above stated.

                                             Signature  ? A. Overgard, M. D.

Date Nov 13, 1950             Address  Stanley, Chippewa

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried       on Nov 15, 1950     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.