Burial Permit19.7
This Dermit serves for a burial permit at destination
PLACE OF DEATH except where local ordinance resuiree loeal ssrmit.
County Hennepin STATE OF MINNESOTA
REGISTRAR'S
°R Excelsior No
Villagfte
City- Permit for Burial or Removal
Date of death Fd. :-:ay 21, 19 45
Full name ilettie Ada Harrison Age 72 arcs
Sex Female Place of birth Excelsior, Minnesota
Disease causing death Drowning (suicide)
MedicalRussell R.Heim, Proposed date of
attendant{ Coroner burial orremovalf May 23, 19 45
Place of burial, removal or cremation -Chanhassen Twp.. Minn.
(City, V' a or .,+e-
%
Conveyance used Hearse Name of Cemeteryw.
Undertaker Bardwell Fun. ServieeAddresaExcelsior, Minn
A certificate of death having been filed in my office in accordance with the
laws of Minnesota, I hereby authorize the burial of the
(Burial or Removat-)
body of deceased person as stated above. In case of death from a dangerous
communicable disease, the burial or removal must be conducted according IP the
rules of the state and local board of health. ` 1.
Dated May 22, 19 45
•Write "Buri-]" or "Remov.l" as the as may be. Burial Wneite'tnust be delivered by she
undertaker to the Beaton. Removal permits most be given to the agent of tranaportaHon company,
and attached by him to boa containing body. Bub-registr-re will write "Bob" before the words
Reaistrar of Deathe" and Licensed Embalmer N " bebw, elways Sivin¢ .=bar
Of license Fine or imprisonment for receiving a body for b.risl w:rL! e"....a
Received l g_ Baton
Name of Cemetery Address
This form may be used for dhiaterammi rdntermeat in aomrdance with aegulathm E8.