Burial PermitSTATE OF MINNESOTA /*7'
DEPARTMENT OF HEALTH Burial - Removal - Transit Permit
Section of Vital Statistics Permit No--4110B--
NAME
o 41100NAME OF DECEASED DATE OF DEATH DEATH COMMUNICABLE?
Arthur Burton I&zan July 212 1966 El Yw ® No
SEX I AGH I PLACE OF DEATH (CIS VW..e T.w.") (Comte)
rime I Jo
METHOD OF DISPOSAL:
BURIAL CREMATION
REMOVAL OTHER (.pedfy)
S ♦ OF MORTICIAN OR FUNERAL DIRECTOR
Mirneapolis Hennepin
PLACE OF DISPOSITION (N.oe of m. 7 w uw 7) (Cite. VDI.[. w Tow.Wi Comte, State)
Chanhassen Township Cewtery Carver Cty., Kinn.
BUSINESS ADDRESS
j- - ♦ mrUnute of dwth e.,bW fwti fD.a ...pained Iv I.w. ". Lmden h M:Wy [le M di. W lite bob-
' SIGN♦ I8 .
(V VDI.F. w TowmWp) (C.aafy) DATE ISSUED
MMMEAPOLIs HEINNEPna I Ilii 1956
SIGNATURE OF PERSON IN CHARGE OF CONVEYANCE +
AUTHORIZED DISPOSITION AS STATEDI SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I DATE RECEIVED
ABOVE OCCURRED ON: (Date)
9-4161 2M BKS 01d, N, M286