Burial PermitXe -t �i 9. 5 BUREAU OF HEALTH - HEALTH CENTER CA, 4-7651
STATE OF MINNESOTAp 555 CEDAR STREET
DEPARTMENT OF HEALTH Burlel - Removal -Transit Permit SAINT PAUL 1. MINNESOTA
Section of Vital Statistics Permit No- 1! el til
NAME OF DECEASED
A rerdfirate of death harina been nld .e regand by hw. P-r-bdoa b herby [ilea t. dbvP of this bob.
DATE OF DEATH
DEATH COMMUNICABLE!
DATE ISSUED
Regina A.
Reim
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amV TS ee.v..2
I Sept 19e 1963
El T.
SEX
COLOR OR RACE
AGS
PLACE OF DEATH (01, VBL,e or T...Mdp) (C. t,)
Fenale
White
84
1 Ste Paul, Ramsey
METHOD OF DISPOSAL:
PLACE OF DISPOSITION (Nue of reseteq or erematoq) (C17. VOIa or T.wa.Wl Co tr. State)
® BURIAL 1 1
CREMATION
3
�
Chanhassen Twep. Cemetery, Chanhassan,MirmesOta
p REMOVAL El
OTHER (rpeedy)
MO
EHAL DIRECTOR
BUSINESS ADDRESSHenry W. Anderson Mortuary
wy�ss
8
I3640 -23rd Ave. So. Mineaolio _
A rerdfirate of death harina been nld .e regand by hw. P-r-bdoa b herby [ilea t. dbvP of this bob.
P R G7&7'R (CRY. Vmne
aae or Towbip)
(Ceaab)
DATE ISSUED
jgl°
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amV TS ee.v..2
SIGNA
OF PERSON IN CHARGE OF CONVEYANCE
AUTHORI
ABOVE
DISPOSITION AS STATED
iJ (Date
SIGNATURE OF,E/ dN OR CRUMTERT
31
I
OOJFFWIAALL
DATE BECRIVED
/
CN'
3
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/1/i 2&— 4
8.9-61 I1f0d'Bkdj
Order No. 16
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8