Burial Permit0
? a-
Burial - Removal -Transit Permit Permit Nn
NAME OF DEC ASED
DATE OF DEATH
DEATN COMMUNICABLE)
Muriel Buell
Sept. 19, 1990
YES
❑�"'
1:1
SEX AGE
PLACE OF OEATH (CITY, VILLAGE oR Toarnsin I leo vTYj
Female 62
Minneapolis
Hennepin
METHOO OF DISP054L:
PLACE OF DISPOSITION (NAME OF CEMETERY OR CwWATCwT( (CITY, vju sff CR Tow mn, CCUNTv,STATEI
®BURIAL F]CREMATIONChanhassen
Cemetery Chanhassen Carver Minnesot
REMOVAL ❑ OTHER (SPECIFY(
SIGNA E OF MORN IAN OR FUNER RECTOR
BUSINESS ADDRESS
Bertas Funeral Home
200 West 3rd St., Chaska MN 55318
c rtificate of death havi been filed as required by law, permission is hereby given to dispose of this body.
2AN
E OFR GI R
CITY, VILLAGE oR TOtR6NIP CWNTv TITLE
DATE ISSUED
Chaska Carver Sub
9-22-90
51 A RE OP'PERSON IN CNA E OF CONVEYANCE
AUTHORIZED DISPOSITION
SIGNATURE OF SEXTON OR CEMETERY OFFICIAL
DATE RECEIVED
AS STATED ABOVE
OCCURRED ON: KATE(
HE -00113 -UJ w84)
This form provided by the Minnesota Department of Health, Section of Vital Statistics Original—Place of Disposition Copy—Sub Registrar