Burial PermitMINNESOTA DEPARTMENT OF HEALTH
Division of Vital Statistics
Registrars No.
Permit for Burial or Removal
A death certificate as required by Minnesota Statutes 1945, Section 144.181,
having been filed in my office, permission is hereby granted for the disposition
as indicated below of the remains of:
NAME I _ AI SEJC I AGE
DISEASE:
COMMUNICABLE ❑
NATURE OF DISPOSITION:
REMOVAL ❑
BIIHW. Ila" CREMATION ❑
VETERAN?
YES ❑
NO [j21- SICNA f577
NAME WAR
This form may be used for
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