Burial PermitSTATE OF
NES
DEPARTMENT OFEALTH burial - Removal -Transit Perm
Section of Vital Statistics
NA HH OF DECEASED
Laura Bertha Dahlstrom
DATE OF DEATH
Permit No—
DEATH
o DEATH COMMUNICABLE!
1:3 Yes ® No
SEX COLOR OR BACK AGB PLACE OF DEATH WHY VNaae or TOwmhip) (Comb)
Female I White 57 Minneapolis I Hennepin
METHOD OF DISPOSAL: PLACE OF DISPOSITION (Na®e of cemetery or ereauton,) Why. Villme or T..ddp, Comtr. Stab)
7 BURIAL CREMATION
] REMOVAL OTHER (apwi
Ify) Chanhassen Cemetery, Chanhassen, Minn
SIGNATURK F MORTICIAN OR FU HAL DIRECTOR II BUSINESS ADDRESS 1838 Central Avenue
ALBINSON-PSTNRSON (Bast Chapel) Mplae
A eertlffrote of death b.W c Mea ttW u r Bred br Yw, per�inMn 1. hereby rl m to dkq of thb body.
8[GN®7�BS,gF,YG sty. Vf he or To--") (ComAy) DATE ISSUED
! ..,...,- v"TN ., ., APR 2 3 925
SIGNATURE OF PERSON IN CHARGE
AUTHORIZED DISPOSITION AS STATED /, SIGNATURE OF 8H%TON OR CEMETERY OFFICIAL OAT6 uL NLV80
ABOVE OCCURRED ON:,ID I , na 9 /7'S 7
12-16-66 1500 Bks. Order Nd. 136