Burial Permit'a 0
STATE PF MINNESOTA
DEPIRTMENT OF HEALTE Buri l • Removal = Transit Permit
Section of Vital Statistics Registration Permit No.
kzAzz OF DECEASED DATE OF DEATH DEATH COMMUNICABLE?
George Oscar Nelson 11- 1982 g"R0 Yes R1 No
Male AGE 81 PLACE OF DEATH (City Vilhff® or Township) (Comty)
I Bloomington, MN. Hennepin
pgjEjruojD 07 DISIPOSAL: PLACE 09? DISPOSITRON (KCIEn(3 09 eamGgeR7 vr ¢ffomABSOU7) (Citi® VuRago ®p T@WM0W0)' COMM97" State)
1EURRAL 0 CRUkZATRON Chanhassen Cemetery, Chanhassen, MN. Carver Co.
P.EMOVAL r'-1 OTHIER (glpedfy)
Li
ORGNA-rUjIg,7 �01? MORTRCIAN OR IFUNERAL DIRECTOR ISUBINESS ADDRESS
520 Second St., Excelsl*or, MN® 55331
A eag-uqko�o @f deaQ having bma fiRo4 QQ Eeqnhr(A f D7 RCW,, pOnDkOkM E3 IAQT067 9§VGM ft dLO)OZO Qq WO 6G49-
01? uOWM&23)) DATE ISSUED
-
Excelsi0or MN. Hennepin 5-82
fuRz 07 PERSON 1N CRARG19 09 CONVE7ANCE
AUTHORIZED DRSPOSETION AS STATED SIGNAPEURZ CIT SEZTON CIE CIEMSTERY OFFECnAl DATEE RECERVED,
Aj3CVg OCCURRIED ON: (Dcto) I I