Burial PermitX,� Aa. 7
STATE OF MINNESOTA
DEPARTMENT OF HEALTH Burial - Removal - Transit Permit 621
Section of Vital Statistics Permit NO
NAME OF DECEASED DATE OF DEATH DEATH COMYUNICABLBt
Lee W. Hutton Jan. 9 1971 ❑ Ya ®N.
SEEI AGE PLACE OF DEATH (Clb VDI... K T --p) (C.®b)
al
Me 75 Years St. Louis Park Hennepin
METHOD OF DISPOSAL: I PLACE OF DIOPOS[IION (Nw d •uetuT .r ena•mn)
® BURIAL El CREMATION
ElREMOVAL❑ OTHER(•I«Irs) Chanhassen Twp. Cemetery Carver$ Minn.
RIG,�N7. OF MORTICIAN 8 FUNERAL DIRECTOR BUSINESS ADDRESS
520 -2nd. St., Excelsior, Minn.
A wtkfk a of bth hs 1tw b. OW u .•..1.•A bT 1... Y ak j.. I. h..bT p.e. f• d1.P•.. •r ihi. b.dT.
SI A OP REGISTRAR (CIW. VELE. n To -mW,) ((.wb) DATE ISSUED
—' Excelsior Hennepin 1-I1-1 1
8I OF PERSON IN CHARGE OF CONVEYANCE
OR
2,
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