Burial PermitCITY OF MINNEAPOLIS
DIVISION OF PUBLIC HEALTH
401 CITY HALL
�T r
PERMIT '1N ? 448 1 p
w/
I
Permit for Burial or Removal
A death certificate as required by Minnesota Statutes 1945, Section 144.181, having been
filed in my office, permission is hereby granted for the disposition as indicated below of
the remains of:
NAME
SEX
AGE
HEB:%= SMALLKOOD
M
I
39
PLACE OF DEATH
MINNEAPOLIS
DATE OF DEATHI
BIRTHPLACE
2,21-51
(State or Comfy) (City, VB. or TMP.)
CAUSE OF DEATH
MEDICAL ATTENDANT
DISEASE:
COMMUN)CABLE 0 OR NON-OOUMUNICABLE
FUNERAL DIRECTOR OR EMBALMER
ADDRESS
LICENSE NO.
ALBIN FINMUL CHAPEL
MPLS
I
1443
NATURE OF DISPOSITION:CE OF DISPOSMON: PRO SED
REMOVAL g —. haeeett
TE
(CemNery)
BURIAL ❑ CREMATION ❑ AT Cihanhaesen,Ml no 2/24/56
VETERAN?
TES ❑ GEHTRU117 M. GILMAN, DEPUTY
NO Q Signature of (Lood or Deputy) Regist—, 's*n
NAME WAR I per "- - �6✓{'��—
This tom may be used for disintermmt-rolntermmt is omordonce with Regulation 23.
F... .1.. 2U04W.