Burial Permit5521 1.2-41 20M
Transportation of Corpse Permit
Minnesota Department of Health
-7
Full name of deceased -------- ---- Al Ar--ROMW44, ------------------------ Date of death ----------.. 3) 19.41
Color ---------- WhIU- Sex-- -9 e....-_ Age.._56-.--- Death due to communicable disease? Yes No (encircle one)
Place of death: - - --------------------------------- Minn-Aep-0-4 -U3. ----------------- .....Mi ... ... esota
- nn - - ----------- -----------------------------
(Name of city, village or township) (State)
Attending physician-----------_------8.--A,..P1cha-j ... M. -.-D --- Address-..... Hopkipos Wpne-s-o.t.a .. .. . .......
Date of transportation -------- MW --- 6-9 ------- -___1 19-41. Transported from....... Minneapolis$ --- Minn"ota-
TO ------------------- (31anhaal
----------------- --------------------------
State of.... minn-eso-ta .......
I hereby certify that the accompanying dead body of -----Ale.xw4er Bon
was prepared by me for transportation in accordance with the regulations of the Minnesota State Board of Health relating
to the transportation of the dead and Was Was not (encircle one) embalmed by me on.- MAY Af . ...... 1941
Signed-- License No.-/7Pf.
CONVEYANCE USED (encircle one) (Embalmer)
Rail nmd -Boat -Wagon - Sleigh
(A-u-t-o-mobi-1Z, Airplane Moore Funeral Home Hovkins, Minnesota.
------ .......... ... --------------------------------- ----------- - ------ -- --- - ------------------------------
(Firm Name) (Address)
PERMIT OF LOCAL REGISTRAR
If shipped by express or as train baggage this permit must be presented to the express or baggage agent. If there is no accompanying
passenger in charge of the remains said agent shall place the permit in an envelope which envelope shall then be fastened to the coffin
If is a passenger in charge, the permit shall be carried by him to the destination of the remains.
In the. -------- Minneapolis - — - --- -- - Hennepin . . ... ....... . . . ..
----- -------- ---------------- --- - --- ------- ------ -
(Name of city, village or township) (County)
State of Minnesota on the-- 5t4 .... day --*V ---- -- - ------- 19-41. permission is hereby given to remove for disposal
Chanhassen --StagofMinnesota
at -------------- in -the Countyd--c-�..jm-----------
---------
the body of- - Alexan.d.er ---- Bongard -- ------------- - - - -------------- above described, if prepared in accordance with the
regulations of this State. Said body to be shipped by baggage, express autos bil airplane, sleigh (encircle one).
-7�7
Signed_ ------ -v ...... ----- ----------------
(Loral keiiitrsuo --- - - --------------------
Signature of person in charge of conveyance-...-------...-__--._._-._._.--..._------___------- -----
FOR USE ONLY BY MINNESOTA LICENSED EMBALMERS
` LaT 7.
FORM H4 IOM
Department of Public Welfare ---Division of Public Health
Office of the Local Registrar Vital Statistics
MINNEAPOLIS, MINNESOTA W
CITY HALL 5/5/1941 Is
A Certificate as Required by Lew Having Been Filed, Permission ts Hereby Granted for the Proper Disposition of the Remains dl
w �
� IG
NAME Alexander Bongard SEX Ma;,e AGE 56 D `
PLACE OF DEATH Swed
gish Hospital
DATE OF DEATH 5/3/1941 NATIVITY Minn. SOC. ST. Married
CAUSE OF DEATH Myocardial rupture
3 '
MED. ATTENDANT P. H. Ficha
2 z
DISPOSITION Chanhassen, Minn. DATe 5/6/194.1 ; °
G
FUNERAL DIR. Moore Funeral Home NO. 1905 gfDD�.VV �.#Ahoes, Mi`$n'. r
$�k�itz
PERMIT
NO. M 9200 COMMISSIONER OF HEALTH. AND LOCAL REGISTRAR EN
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