This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  William Mayenschein

Place of Death  Butler, Clark Co., Wis.

Date of Death Aug 19, 1955              White    Male       79

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

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  8/19/1955                   Address  Thorp, Clark

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried      on Aug 22, 1955         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.