Burial PermitSTATE OF MINNESOTA
DEPARTMENT OF HEALTH
Section of Vital Statistics
Burial - Removal - Transit Permit
o,°,.,t L{. 3
Permit No- 196
NAME OF DECEASED
DATE OF DEATH
DEATH COMMUNICABLET
Frederick Wilhelm Anderson
I Feb.26y1961
❑ Y.. ® N.
SEXI
Malas
COLOR OR RACE I AGE
White
I PLACE OF DEATH
Rxnel ci or
(am YBly 0owenew
(Ce ty)
9ennanin
METHOD OF DISPOSAL:
PLACE OF DISPOSITION (N.. of mmet r or
Towmh/F, C tY, Stab)
'3
1BURIAL
I I CREMATION
❑ REMOVAL
❑ OTHER (.Deeuy)
Chanhassen Twn. Cemetery
Carver Minn.
BIGNATIIRE OF
OHT'fCIAN O8 UNEHAL DHtSCf08
BIISINii48 ADDRESS
520 -2nd. St., Excelsior, Minn.
A ruffft of dmtb hat(n, bm. H1.d m ro ul-d by kw, permL.iov 1. hereby eirm b div of t►Y heft.
SIGNSIGNJOOft F REGISTBAR (City, Vm.t[. er To -v") (Comb) DATE ISSUED
Excelsior Hennepin Mar.1,1961
SIGNALS OF PERSON IN CHARGE OF CONVEYANCE
AUTHOR/ DISPOSITION AS STATEDI SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I DATE RECEIVED
b)
ABOVE OCCURRED ON:(D.
7�0 1500 Bks. 8.041pt.