Sam Conor

Butler, Clark County, Wisconsin

 

This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Sam Conor

Place of Death  Eau Claire, Eau Claire Co., Wis.

Date of Death  December 3, 1949     White     Male     80

Cause of Death 

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

 

Cemetery/Crematory

 

Location (City, town or country)    (State)

 

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, Wisconsin

To dispose of said deceased as above stated.

                                             Signature  Carol M. Comrie, Deputy

Date  December 6, 1949      Address  Eau Claire, Eau Claire Co.

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried              on Dec 7, 1949   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.

 

 

 

 

 

 

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