Burial PermitSTATE OF MINNESOTA 54.7
Section of t Vita StatiOF HEALTH
EARegisT anon Burial- Ranoral -Transit Permit permit N -2 �-�
NAME OF DECEASED �� DATE OF DEARTH �DEATH COMMUNICABLET
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SEX AGE I PLACE OF DEATH (Cats VUI ,..r T.ddv) (C...y)
METHOD OP DISPOSAL:I PLACE O DISPOSITION (N.-, of r -tI w rr.-.twF) (C14
❑ BURIAL CREMATION
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FUNERAL DIRECTOR / BUSINESS ADDRESS
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S!!,!!.4wURz OP RE (Cub. VUl..ter T wwmup) (f:.��) I DATE ISSUED
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SIGNATURE OF PERSON IN CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION AS STATEDI SIGNATURE OF SEXTON OR CEMETERY OFFICIAL I "�•� �•'�^'�'
ABOVE OCCURRED ON: Mau)