Burial PermitSTATE OF MINNESOTA
DEPARTMENT OF HEALTH Burial - Removal -Transit Permit
Section of Vital Statistics
x't a9. -/
Permit No_ 93
NAMR OF DECEASED
DATE OF DEATH
DEATH COMMUNICABLE?
James Alfred YALwell
Sept•5, 1959
❑ Yea ® No
SEX COLOR OR MACH
AGE I
PLACE OF DEATH (Cite Village or Towm&b)
(Comp)
Male (White
88 Yr
. Chanhassen Twp.
Carver
METHOD OF DISPOSAL:
PLACE OF DISPOSITION (Name of e.arteq or eressatorr) (CYJCVfl8EOr Tow=Wp, Comp, State)
® BURIAL CREMATION
❑ REMOVAL OTHER (apedp)
Chanhassen a rIy,.pe
Chanhassmt Carver Kirrl.
SIGNATURE. OF MO DIRECTOR DIRECTOR
BUSINESS ADDRESS
,1 %i
Si(�iTLy_ St. h'M8j_Rinr.
Minn.
A, certificate of death baeina been filed oe rpnl:ed br law, per,oi.a(on is berebr airsn to die o.e of this bode.
OF REGIS (COME[Bot. dEXOINW) (Camp) DATE 188UED
e,; nr Hennepin Sept 8,1959
SI TUBE OF PERSON IN CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION AS STATED I SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I DATE RECEIVED
ABOVE OCCURRED ON: (Date)
1038 1500 Ske. Rep. No. 42 8 '