Disposition Permit4
DISPOSITION PERMIT
DECEDENT'S NAME
HARRIET LOUISE ELMBLAD
DECEDENT'S ALIAS
HARRIET L. ELMBLAD
SEX
FEMALE
DATE OF BIRTH
AUGUST 28, 1912
DATE OF DEATH
DECEMBER 30, 2005
PLACE OF DEATH
HAVEN HOMES OF MAPLE PLAIN
1520 WYMAN AVE
MAPLE PLAIN, MINNESOTA
FUNERAL DIRECTOR
M3058
WALLY GELECINSKYJ
FUNERAL HOME
0144
HUBER FUNERAL HOME & CREMATION SERVICE
520 SECOND STREET
EXCELSIOR, MINNESOTA 55331
PLACE OF DISPOSITION
FAIRVIEW CREMATORY
Final Disposition
Chanhassen Pioneer Cemetery
(Urn Burial)
4/24/2006
According to Minnesota Statutes, section 149A.93, subdivision 3,
section 144.221, and Minnesota Rules, part 4601.1500, the fact of
death has been filed with the Office of the State Registrar.
Barbara A. Carter
State Registrar
Authorized Disposition Occurred on:
Signature of Crematory or Cemetery Official:
(type or print name of crematory or cemetery official)