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Burial PermitSTATE OF MINNESOTA DEPARTMENT OF HEALTH Burial - Removal - Transit Permit Section of Vital Statistics Registration Permit No- L NAME OF DECEASED m OJDATE OF DEATH DEATH COMMUNICABLE? i _ // _' _ _ /i*i_-.Z C{_ r7> M Ys M No ACE METHOD OF DISPOSAL: 0 ® BURIAL CREMATION REMOVAL OTHER (sped[y) SIGNa OF MORTICIAN OR FUNERAL DUM PLACE OF DEATH (City VBhFo or TwrWp) PLACE OF DISPOSITION (Slosse oT ao't" s -d (City. VMue or Ta Canty, Soto) / A sNflub of As9 bpA-F bees, OW s :guired by m.. poesy Y be.&F Find 4 dopes of tbb body. GNA OF RW.=TRAR (CIty, vmI of T. -Miff` ( ) DATE ISSUE �-0 �t V 4 1/0-1- -;&3 Hlb�fATURB OF PERSON IN CHARGE OF CONVETANCR OF SEXTON OR CEMETERY OFFICIAL