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Disposition PermitDISPOSITION PERMIT DECEDENT'S NAME NELLIE ADA ANDERSON AKA / ADA ANDERSON GENDER FEMALE DATE OF BIRTH /AGE 07/30/1933 / 81 DATE OF DEATH 12/01/2014 RESIDENCE PLACE OF DEATH 14900 CROWN DRIVE MINNETONKA, HENNEPIN, MINNESOTA FUNERAL DIRECTOR DEAN C HEINS M3847 HUBER FUNERAL HOME & CREMATION / LIC # 0759 FUNERAL HOME OR 1801 COMMERCE BOULEVARD OTHER ENTITY MOUND MINNESOTA DISPOSITION FACILITY FAIRVIEW CEMETERY ASSOCIATION MINNETRISTA MINNESOTA PLACE OF DISPOSITION CEMETERY CHANHASSEN PIONEER CEMETERY CHANHASSEN CARVER MINNESOTA According to Minnesota Statutes, section 149A.93, subdivision 3, section 144.221, and Minnesota Rules, part 4601.1500, the fact of death has been filed with the Office of Vital Records. Molly Mulcahy Crawford STATE REGISTRAR DISPOSITION PERMIT ISSUE DATE 12/02/2014 02:19 PM (SIGNATURE OF FINAL DISPOSITION FACILITY OFFICIAL) (PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL) Rev 12/2013