STATE OF WISCONSIN

BURIAL PERMIT

Penalty for Burying Without a Permit, $20 - $200

April 5, 1938

                                                                                  (City, Township or Village)

A satisfactory certificate of death having been furnished to me, as required by the laws of this State, permission is hereby given for the burial of  Jennie Kile

Who died at  Eau Claire, Wis.            in the county of  Eau Claire

On  April 4, 1938                       the cause of death being  cerebral apoplexy

Place of burial:  Butlerville Township

                                                                 (Signed by)  D. D. Stookey

                                                                    (Registrar, Deputy or Sub-Registrar)

                                                                               Arthur Morrison

Undertaker or person in charge                                      (Sexton)

John G. Bogumill

Date of internment:  April 7, 1938

                                                                                           (Name of Cemetery)

This permit must be delivered to the keeper of the cemetery where the burial occurs, and should be endorsed by him and returned to the local registrar of his district.