Burial PermitSTATE OF MINNESOTA
DEPARTMENT OF HEALTH
Section of Vital Statistics
NAME OF DECEASED
Ella Priebe
SEX COLOR OR RACE
Female White 76
METHOD OF DISPOSAL:
a BURIAL 1:1 CREMATION
un REMOVAL n OTHER (npedfy)
Burr -Removal -Transit Permit
I DATE OF DEATH
L"C6KE
AGE I PLA
�/-6-7a.
Permit No
UNATH e:VMg1uxIuA u1 T
El Van ❑ No
CS OF DEATH (City Vianza . T.waehip) (C—ty)
Albany, Stearns Co., Minn.
PLACE OF DISPOSITION (Naap of ceaeiery or ere®atorr) (City. Village or Towmhip,
Chanhassen Cemetery. Chanhassen Twp.
SIGNATURE OF MO T CIAN OR FUNERAL DIRECT I BUSINESS ADDRESS
Chaska, Minn.
seats cath having been £Jed as reovired by low, per duion I. hereby given to disp000 of thin bob.
SIGNATURE OF REGISTRAR (City. Village or Townohip) (Ceonty) I DATE ISSUED
Chaska Carver
SIGN URS OF P INC E OF CONVEYANCE
StW)
ABOVE CC DISPOSNz (N AS STATB9 I BIGI.jATIIEE OR 68839N OR CEM6FRHn „ Y OFFICIAL DATE
�BHnCEIV®
ABOVE OCCURRED ON: (Date) (� / _�� t{`.(.–/t-_Y_C.L.i�/ "�'^� 7 jag W
\ 8.941 1500 Bks. Order No. 15