This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Rose Mayenschein

Place of Death  Stanley       Chippewa          Wisconsin

Date of Death  July 10, 1959    White      Female     74

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

Location (City, town or country)    (State)

Twsp Butler, 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.

R. V. Izydorek

To dispose of said deceased as above stated.

                                             Signature  Myrtle Bogumill

Date  July 13, 1959             Address  Thorp     Clark     Wis.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried                     on  July 1959            in  Butler Cemetery

Located at  Butlerville                   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.