Burial PermitSTATE OF MINNESOTA y �--
DEPARTMENT OF HEALTH Burial - Removal -Transit Permit
Section of Vital Statistics Permit No -
NAME OF DECEASED DATE OF DEATH DEATH COMHUNICABLET
Etta M. Anderson Aug.28,1960 ❑ Too �] No
SEX COLOR OR RACE AGE PLACE OF DEATH (CHrxKjL@VdMff-4MRft) (Comb)
Female ' lite 67Yrs. Minneapolis Hennapin
METHOD OF DISPOSAL: PLACE OF DISPOSITION (Nom. of a mete or eramatoq) (City. VHIoSs or Tow hip. Ceenty, State)
® BURIAL Q CREMATION
REMOVAL ❑ OTHER(epeeify) Chanhassen Teanship Cemetery Carver Cty. Minn.
SIGNATURE OF O"ICIAN OR F`' CTOH BUSINESS ADDRESS
%%/ 7==' I 520 -2nd. St., Excelsior, Minn.
A whidmte of death Lavin[ Leen filed u required by Lw. perminlon Is hereby .hep to diepr, of this body.
EIGlN. A F "TRAIL rwiodC/QI.S.T.ViHoeo or Towueip)IVili �liCAiULIJ hlCltiVCDATE ISSUED
J a
1960
119
10-58 1500 Blu. Req. No. 42
SIGNATURE OF SEXTON OR CRMETEHY OFFICIAL