Burial PermitCITY OF MINNEAPOLIS
DIVISION OF PUBLIC HEALTH
PERMIT TT) -5932 W
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
FesSEX
70 AGE
H
PLAC FDFq
DATE OF DEATH
BIRTHPLACE
ranks II H08nitaT.
(State or County) (City, Vil. or Twp.)
12-26-53
Minn.
CAUSE OF DEATH
MEDICAL ATTENDANT
DISEASE:
COMMUNICABLE ❑ OR NON -COMMUNICABLE [IC
I Berg
FUNERAL DIRECTOR OR EMBALMER
AD SS
LICENSE NO.
Albinson'Peterson Chapel
M
ls., nn.
NATURE OF DISPOSITION:
PLAGE�hDI�SPS SIa")N:
LiII 8
PROPOSED
REMOVAL ❑
DATE
(Cemetery)
' BURIAL E CREMATION ❑
AT
Ch(Cemetery)
12-28-53
VETERAN?
YES ❑
NO ❑ Signature of (Local or Deputy) Registrar
NAME WAR I 12-28-53 bt
This farm may be used for disinterment-rainterment in a¢ordanca with Regulation 23.
N 11108 ..Nw.