Burial PermitBurial - Removal - Transit Permit P n,* Np 05059009
NAME OF DECEASED
DATE OF DEATH
DEATH COEMILABCABLET
Jeffrey Scott Hoskins
May 5, 2002
Elm ID No
SEA AGE
PLACEOFDEATH ICRY,vAlAOE ORTOYNIeHOI (COUNTY,
Male 1 98
Waconia, Minnesota Carver
METHOD OF DISPOSAL
PLACE OF DWPOSRION (MM OF CEMETERY OR CREMATORY) (CRY, VILLAGE OR TOWNSHIP, COUNTY, STATE)
SURUL FICREMATON
Chanhassen Pioneer Cemetery
FIREMOV OTHER IFYI
Chanhassen, Carver ,MN
F MORTICIAN FUNERAL 9TECTOR
'
BUSINESS ADDRESS
520 Second Street Excelsior MN 55331
A celyfico d th having beEi
as required by law, permission is hereby given to dispose of this body.
RE OF GIS
(CIT/.aLLAGEORTOWNSHIPI (coLwm RRLE)
DATE ISSUED
Excelsior Hennepin Sub -Registrar
5-6-2002
51 E 0=11i M CIONi
AUTHORIZED DISPOSITION
SIGNATURE OF SEXTON OR CEMETERY OFFICIAL
DATE RECENED
AS STATED ABOVE
OCCURRED ON 3"1 May 8, 2002
HE -00113-03 (7/84)
Original—Place of Disposition Copy—Sub Registrar