Burial PermitBurial -Removal -Transit Permit
rTVL�. �ro.s
/PermitNo.
—
NAME OF DECEASED
DATE OF DEATH
DEATH COM.IUNI4=0kBLE7
Helen A. Hillier
May 3, 1992
OYES ]B—
SEX AGE
PLACE OF DEATH CITY. vs...OR TOMNSNIP "`7'Female
83
Wadena Wadena
MET OID OF dSPOSAL:
PLACE OF DISPO6ITON (NAME OF CEMETERY OR CREMATORY( (CITY, VILLACIS OR TORNSHIP, CWNTY,STATE)
BURIALCREMATION
Chanhessen Cern. Chanhessen, Hennpin Co., Minnesota
OREMOVAL ❑ OTHER (SPECIFY)
SIG E O TICIAN OR FUNERAL DIECTOR
BUSINESS ADDRESS
M-2802
310 Bryant Ave. S.W. Wadena, Minnesota 56482
A certificate of death having been filed as required by law, permission is hereby given to dispose of this body.
SIGN OF *F CITY. VILLAGE OR TORNSHIP CWNTY "TLE
DATE ISSUED
IL:/fµiYA//_„I�I�.a_— Wadena Wadena Sub -Registrar
5-7-92
SIGNgTV REO P RSON IN CHARGE OF CONVEYANCE
AUTNORIZED 015POSITION
AS 5"rATED AISOE
51 NA RE OF SEX Ort CEMETERY OFFICIAL
DATE ECEIVED
S1a UR ED ONV(DATE) 9.�-�
a.
5,6-9z
HE -00113-03 (7/84) Ll U
This form provided by the Minnesota Department of Health, Section of Vital Statistics Original—Place of Disposition Copy—Sub Registrar