Burial PermitBurial - Removal - Transit Permit
Permit No.600E 69.7
NAMEDECEASED
DATE OF DEATN
DEATH COMMUNICABLE?
7-5-1994
❑YE' Q"�
Dennis Dale Moorhead
SEX AGE PLACA. OF DEATH (CITY. VILLAGE OR TOVn6NIP (COIM}Y)
Carver County
54 Chanhassen, MN.
l
Male
MERIOD OF DISPOSAL:
PLACE OF DISPOSITON (NAME OF CEMETERY OR CREMATORY( (CITY. VILLAGE oR TOINSHIP. COUNTY.STIRE(
BURIAL ❑CREMATIDN
Chanhassen Pioneer Cemetery, Chanhassen, MN.
❑ REMOVAL ❑ OTHER (sPECIPY)
SIGNATURE OF MORTCI OR FUNERAL DIRECTOR
BUSINESS ADDRESS
�.. (
520 Second Street, Excelsior, MN. 55331
A certificate of death having been filed as required by law, permission is hereby given to dispose of this body.
SIGNA R OF REGIS rR CIT-, vuUAGE oR TOINSNIP CWMY (TYLE
DATE ISSUED
Excelsior MN. Hennepin Co. Sub Registrar
7-6-94
SIGNATURE OF PIERSciN IN CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION
SIGN RE OF SEXY OR CEMETERY OFFICIAL
DATE RECEIVED
AS TEID ABOVE
F
qawp /,??,/
OCCURRED
ED ON: Io.)
HE -00113-03 (7/84)
This form provided by the Minnesota Department of Health, Se on of Vita I Statistics Original—Place of Disposition Copy—Sub Registrar