Burial PermitOF MINNESOTAApt
sY i
DEPART
D ENT OF HEALTH Burial - Removal - Transit Permit I.
Section of Vital Statistics Registration
Permit
NAME Or DECEASED DATE OF DEATH DEATH COKNUNICA13LRT
ALEX BONGARD (June 14, 1977 I El Y« ® No
BBE AGB PLACE OF DEATH (Cly Ym-ro or T -w- dp) (COMW
Male 70 Hennepin County Medical Center, Minneapolis, Hennepin Co.
METROD OF SPOSAL: PWCB OF DISPOSITION lNw of esotoq or cru -Mer) (Cly, YBLn or Tewvo\Ir, Coot', SIa41
B LL � CRBMATION
MovwL � orREs (. » L�ardlassen Cemetery Chanhassen Caxwer I+finn.
SIGN TUBE rHoar^cuN F E 1 = / HoeDrEssADDBEee Shakopee, MINNESOTA 55379
A/lfi
arBN(to ►-el-r Mea Old u :et-Iw y im wr-I-I,a b bmy ■1� To dwp— d " My.
(Cly. VIWao er Tow,AM,) (Cwy) DATE ISSUED
Minneapolis Hennepin Co. I June 14, 197
SIGN[ ES OF PER90N IN GB OF CONVEYANCE
AUTHORIZED DISPOSITION AS STATEDI SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I DATE EBCE/VW
ABOVE OCCURRED ON:(Doa)