Burial PermitCITY OF MINNEAPOLIS
DIVISION OF PUBLIC HEALTH
401 Cin HALL
/?- to
PERMIT N 6305 W
Permit for Burial or Removal
A death certificate as required by Minnesota Statutes 1945, Section 144.181, having been
filed in my office, permission is hereby granted for the disposition as indicated below of
the remains of:
NAME
SIX
I AGE
Edv in Bennett Harrison Sr.
Male
61 rrs
PLACE OF DEATH
DATE OF DEATH
BIRTHPLACE
.firm- Henn, Ming�anppl'
(State or County) (Crty, Vll. or TwP.)
1"lajr 30r 1955
Illi: lois
CAUSE OF DEATH
MEDICAL ATTENDANT
DISEASE:
COMMUNICABLE ❑ OR NONCOMMUNICABLE
"llton Seifert,l`1Ti
FUNERAL DIRECTOR OR EMBALMER
ADDRESS
LICENSE NO.
riuoer Funeral home
Excels' or 1,1
nn. #3082
NATURE OF DISPOSITION:
I PLACE OF DISPp51TIpN:
L.pXCelSlOr 1T'TP/
PROPOSED
REMOVAL ❑
DATE
(Cemetery)
1
BURIAL ® CREMATION ❑
.LT � ; er CoMtZ.xinn
LT
6-1-55
VETERAN? �.•, ll;,.:,._i'./y�"✓L"'C" .
YES M
NO ❑ Signature of (I=[ or uty) Reghtrdf
NAME WAR '.�+'I."fl I Ha}' 31. 1955
This form may be used for disinterment -reinterment in aaordance with Regulation 23.
rORll 11108 '.'Millille.