Burial PermitBurial - Removal - Transit Permit
Permit 140.
NAIME car DECEASED
GATE OF DEATHDEATH
COMMIINICAaex?
Stanley Ransom Hillier
April 16, 1995
❑YNi ER
S
AGE
PLACE OF DCAIrH CITY, VILLAGE OR TO"S..P COUNTY
Male
86
I
Wadena Wadena
ETHOD OF DISPOSAL:
PLACE OF DISPOSITION INAME OF CEMETERY OR CREMATORY) (CITY, YIWOE OR TORMNIP, COUNTY,ETIIIE
FX BURIAL E] CREMATION
Chanhassen Cent. Chanhassen, Carver Co., Minnesota
❑ REMOVAL ❑ OTHER (aPECIFY)
IAN CA FUNERAL DIRECTOR
BUSINESS AO[XiESS
M-2802
310 Br ant Ave. S.W. Wadena Mn. 56482
A c rtificate of death having been filed as required by law, permission is hereby given to dispose of this body.
ED Wadena Wnrlpna Siib-rPqistrar 14-18-95
K.� ' clTv, VlwcE oR TOWNSHi. Cou NTr Yl DATE ISSu
SI NA RE F ERSON IN CHARGE OF CONVEYANCE
AUTHOR12m DISPOSITION
SIGNATURE OF SEXTON OR CEMETERY OFFICIAL
DATE RECEIVED
AS STATED ABOVE
OCCURRED ON: (OATS)
HE -00113-03 (7/84)
This form provided by the Minnesota Department of Health. Section of Vital Statistics Original—Place of Disposition Copy—Sub Registrar