Transportation PermitFOR USE ONLY BY MINNESOTA LICENSED EMBALMERS
MINNESOTA DEPART\TENT OF HEALTH
TRANSPORTATION OF CORPSE
1 PLACE OF DEATH STATE OF MINNESOTA
County __ -e_n_neolc Division of Vital Statistics
Township Ft. Snelling_ CERTIFICATE OF DEATH a
.r
Hot. Metr61 ._
B.—___ ------ .—_ b 1)eahewnn a. h___.__.._
Village -__.___---.- taus,. evmu,e u or Wel u b, owr h, la+l wrhtnr or hu deport.)
r
City of La oboes„ H.apitel Svo Ward
((t arm .reams u . uerplmt or wn[awe. pee m aANs ls[sd of .[m[ nd Hamner)
2 FULL NAME _._ __- Edward Kola i
(s) awia.ew, a.. _. Chanhassen Minn.
(C�1 phw et �EaEe)....—_ (it lfou d ab or rove as aw[el
Lm(m et tr:dmw to nt, or tame .hew awn .roams m. m^. do. Do. bet In D. e. u .t (Yetp e4m1 m. mo•. as �
a esQbr w Eaoa s oma..... wNe ed, or
gale It white I" n(le�I � Wo") at DATE W DEATH tmmm, say, .r year) Mar 31e . u32
g as 1 HEREBY C E E S I I Y, That r •tended dseared from
b If mens,. tido.ed or a).errea .f . n—, m 1s_— 1
apaBABD
(oA yliPEof 1 loot sow h—.man b_: de.th 1. WA i
Y Ws, .rea[rM w 14 bt. NM+Mw,+
d DAY. Or EIESa (moth, 4). sed re.r) The PEIBAEY DHDBitraO GDBC N dean ti
T ABE Yrwr
Name Dan IIIf oes mu Ara".
37 I 1, day. — Multiple Scierasis
t rnae. peoreuleo, w veruem•r moa w
,work do.., a enateme (pp. M
robs,. wets,. hoouwsrr..ta Fers.r
o IWvtn or hrinw is .hbl most
w dos,. u roll.+'. We (and
10 Date dww.iedva 1 SaW Was
mu wruwebo (mevm ovd smwt as
sW
9INY PLGCP tan or to.m) Chanhassen Mien.
(Smote v m®tn)
u EASE Cuetaf Kelm
]a ERSEPLAZZ (db or loom) Germany
(smote or wmW)
idllAm" Bala Augusta Kelm
is HRTA "" (d4 w inwes more) Ra.r min
esrt..r w®err)
wq*,Dr Hospital Records
P ae or Drsted hanhaasan..III=
Is
Crmeamn wows N tmynta•w to erdn H sewn Ovists,
O)
(a
Da wo ewwdoe stored. stmt
N R deo corditba for must it ti ••+•••
Deb of eym•tion—wu thN u .ebyn l_. No
Y If dnm ti doe N e.uroat new (viols,.) 0 to .W the fenewb.:
Awldut. aobue, . hemtold.l mob m Won . to
ohm d tolar, -
-I--(smolt, fin w soma nnn. am M.)
ii a fr .hemr Wan oeeems m isdomy, to bene. or V sahas slew.
Nnaer of Wrvy
Eames w Wen
n Was diems, w ivlvr Is say .n reloted to wwwtba of deossral_
n w, owdfr._._
(areal)._. R.B._Fralis Med. Gfflcer in ¢hMrge
(Asarco) .sterane_Adainstrrgtlen Hospital
PERMIT OF LOCAL BOARD OF IIEALTH
This permit must be property signed, and with Physician's Certiseate presented to the Railroad or Express Agent before
body can be shipped. it must he given the passenger in charge of the corpse or if shipment is by
express, placed in an envelope and attached to the coffin box.
Io the_—___—_.Ta>�mshllf__.�.at_—Et._SIIeh iso
....... —County of_ Hennepin__
favor To .ods")
State of__.—. 'SnpfL o@a__—on the_. 2nd—. --_-----.__day of A)m11 _lv 32
Penummon is hereby given to remove for burial at C saes_
In the County of C 'Ser state of_ MSanestta
the body oL.__._—,Zidword Kele _.__, above described, if prelates in accordance
with the regulations of this state, printed on the but of this permit.
To be accompanied by. Via Hearse _ -os escort.
atnaw oisvl k rot auW b..0 s rssm for wt dobx oo)
S goad
ealth Gior Chairman.
r wt orw
(DioJ.Neh d. ss, awls)
Detach at this perforation and securely attach this label to the outside case
CORPSE TRANSIT LABEL
Licensed Embalmer's Certiaeste License No 1704
I bereby certify that the arrompeoying dead body of Edr•«1 K.n m _.________ _
to bttramported to_&haAilaBBsiL_.__-_ state of_ YSnaesaSa_Jn raw ot__V16 Hearst
has been prepared for transportation in conformity with Regulatione Nos. 36, 37, 38 ao rd.ri to the transporta-
tion of the dead m this Stat ___ 4
STATION BAGGAGEMEN Must Enter
TION POINTS TiIE TICKET READS which b
of the Ticket, the Exact Route and VIA WHAT JUNG
1. charge of the rena.l.,
ou