Disinterment CertificateSTATE OF
ESOTA
DEPARTMENT OF HEALTH urial - Removal - Transit Permit --
Section of Vital Statistics Permit No
NAME OF DECEASED DATE OF DEATH DEATH COMMUNICABLE!
Laura Be Dahlstrom April 26g 1957 ❑ You we
SEX COLOR OR RACE AGE PLACE OF DEATH ICRP Vill.`e or Townehip) (Comb)
remale I White I57 I Minneapolis Henn.
METHOD OF DISPOSAL: PLACE OF DISPOSITION (N.me of a.eteu or rreuetorr) (City. VRiega or Toweehip. Comb. Stete)
❑ BURIAL ❑ CREMATION
I s ntermen from Chanhassen Cemetery and Reinterment in
❑ REDX7AL El OT y) Hill aiAn (lmm�+nry Minnn uv.nl is QN %-/-155¢
SIGfjAT4RE OF MORTICfq0qR FUNERAL DIRECTOR BUSINESS ADDRESS
¢.. #1279 Albinsoa-Peterson(Last Chapel)
r$ to of loth barter beam filed w required by low. oerudaden is hereby given to diepooe of thle body.
SIGNY�39 OF REGISTRAR. (City. Village ar Town") (Comty) DATE ISSUED
SIGNATURE OF PERSON IN CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION AS STATEDI SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I DATE RECEIVED
(D
ABOVE OCCURRED ON: ere)
9-1037 ISW Eke. Req. No. 42 F Qp