This permit must accompany remains to destination

Bureau of Vital Statistics                      Wisconsin State Board of Health

BURIAL --- TRANSIT PERMIT

Full Name of Deceased:  Elsworth Anson Harrington

Place of Death  Hudson, St. Croix, Wisconsin

Date of Death  2-26-63              White              Male     53

Cause of Death  Crushed chest - internal injuries

(Completion is not necessary for Wisconsin burial)

Burial, Cremation, Removal

Burial

Cemetery/Crematory

Butlerville

Location (City, town or country)    (State)

Thorp, 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.

Chester Burke, Hudson, Wisconsin

Georgas Funeral Home, Neillsville, Wis.

To dispose of said deceased as above stated.

                                             Signature  Dr. A. W. Lumberg, M. D.

Date  2-26-63                       Address  Glenwood City, Wisconsin

Cemetery or Crematory Authority Shall Fill Out Space Below

Body was  buried     on Mar 1, 1963     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.