Burial PermitBurial - Removal - Transit Permit
Permit No. <,_.
NAME OF DECEASED
DATE OF DEATH
DEATH COMMUNICABLE?
Trent R. Powers
31 Oct 65
DYES NO
SEX
AGE
PLACE OF DEATH (CITY, VILLAGE OR TOWNSHIP) (COUNTY)
Male
35
North Vietnam
METHOD OF DISPOSAL:
PLACE OF DISPOSITION (NAME OF CEMETERY OR CREMATORY) (CITY, VILLAGE OR TOWNSHIP, COUNTY, STATE)
:UT URIAL F]CREMATIONChanhassen
Pioneer Cemetery
OTHER (SPECIFY)
REMOVAL 1:1
F]
Chanhassen, Minnesota
SIGN A E OF MORTIC O UNEFPkL DIRECTOR
BUSINESS ADDRESS
;-�
Bertas Funeral Home 200 W 3rd St. /Chaska, Mn. 5531
A certificate of death having/JITen
filed as required by law, permission is hereby given to dispose of this body.
SIGNA OF REGIS TR
CITY, VILLAGE OR TOWNSHIP) (COUNTY) (TITLE)
DATE ISSUED
4J�
Chaska Carver Sub.
4-15-88
7G-iJRE O PERSON I1q CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION
SIGNATURE OF SEXTON OR CEMETERY OFFICIAL
DATE RECEIVED
AS STATED ABOVE
OCCURRED ON: (DATE)
H E-UU-I I J -UJ ( //64)
This form provided by the Minnesota Department of Health, Section of Vital Statistics Original—Place of Disposition Copy—Sub Registrar