Burial PermitFORM H I IMF"
Department of Public Welfare---Division
of Public Health
Office of the Local Registrar of Vital Statistics
MINNEAPOLIS, MINNESOTA
Januarq 18, 1929
CITY HALL,
A Certificate a. Re W,.d by I.tr H.Al Been F' Perini. . i. Hereby Granted for the Pr Diepoddon of the R.m .. of:
NAME Dorothy Rudolph SEX e2 le
AGE 28
PLACE OF DEATH St. Barnabas Hospital
DATE OF DEATH Jran 1f3, 1.929 NATIVITY j=inn.
SOCIAL STATE married
CAUSE OF DEATH 'Ultiple obstruction of bowel- Peritonitis
MEDICAL ATTENDANT G. Sheryl Cabot
PLACE OF DISPOSITION Chanhassen Cem. Carver Co.BIinr_.
DATE Jan 21, 1929
UNDERTAKER (�uyq t I S NO. ADDRESS iiinls .
PERMIT
n
444
No. F ij
COMMISSIONER OF HEALTH AND LOCAL REGISTRARJS`