STATE OF WISCONSIN

BURIAL PERMIT

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

Aug 1^st, 1928

                                                                                  (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  Mila Audorff

Who died at  Sacred Heart Hospital        in the county of  Eau Claire

On  August 2, 1928                the cause of death being  acute pancreatitis

Place of burial: 

                                                                 (Signed by)  J. F. Farr

                                                                    (Registrar, Deputy or Sub-Registrar)

Undertaker or person in charge                                      (Sexton)

John G. Bogumill

Date of internment: Aug 4, 1928                                    Butler

                                                                                           (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.