Disposition PermitAa
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STATE OF MINNESOTA p
DEPARTMENT OF HEALTH Burial -Removal -Transit Permit
Section of Vital Statistics Registration Permit No_
NAME OF DECEASED DATE OF DEATH DEATH COMMUNICABLET
Ruth B. Hutton. May 5, 1977 ❑ Tea ® No
SEX AGB PLACE OF DEATH (CIty VDlai, or Township) (Coanty)
Female 77yr8 St. Louis Park Hennepin
METHOD OF DISPOSAL: PLACE OF DISPOSITION (Nm* of t ot,ry or it atoq) (City. Vmaa, or Township. Copaty. Sbte)
® BURIAL ❑ CREMATION (IVA
❑ REMOVAL El OTHER (.p.af,) Chanhassen Township Cemetery Chanssen ''`inn.
SIGNATURE OF MORTICIAN RECTOR BUSINESS ADDRESS
O UNEHAL DI520 2nd St. Excelsior, Minn, 55331
A orfifkoq of doth k.,br been filed u r Rired by law. per-iofon 6 bereby Woo to diapoo of thi. body.
BIG= OF REGISTRAR (City. VDb.po or Towaahip) (Coanty)I DATE ISSUED
Excelsior, Minn. F.ennepin 5_7_77
OF PERSON IN CHARGE OF CONVEYANCE
AUTHURIZED DISPOSITION AS STATED SIGNATURE OF SEXTON OH CEMETERT OFFICIAL DATE HECHI ED
ABOVE OCCURRED ON: (Date) :i / /^