Obit: Warden, John Fred (? - 1919)
Contact: stan@wiclarkcountyhistory.org

Surnames: Warden, Conklin

----Source: Butler Township, Clark County, Wis. Death Records

 

 John Fred Warden

Butler, Clark County, Wisconsin

 

STATE OF WISCONSIN

BURIAL PERMIT

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

 

Town of Butler Nov 29th, 1919

                                                                                  (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  John Fred Warden

Who died at  Town of Butler             in the county of  Clark

On Nov 27th, 1919                          the cause of death being  gun shot in the head

 

Place of burial:  Butler Cemetery

                                                                 (Signed by)  H. C. Conklin

                                                                    (Registrar, Deputy or Sub-Registrar)

                                                                              

Undertaker or person in charge                                      (Sexton)

H. C. Conklin

Date of internment: Nov 30, 1919                                   Butler Cemetery

                                                                                           (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.

 

____________________________________________________

THIS "STUB" TO BE KEPT BY PERSON ISSUING PERMIT

 

______

 

BURIAL PERMIT

______

 

1.  Name of deceased:  John Fred Warden

 

2.  Place of burial:  Butler Cemetery

 

3.  Date and place of death: Nov 27, ’19 Town of Butler

 

4.  Disease causing death:  Gun shot in head

 

5.  Cause of death given by:  B. A. Cole

 

 

6.  Undertaker: 

 

 

 

 


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