Burial PermitSTATE OF MINNESOTA
DEPARTMENT OF HEALTH Burial - Removal - Transit Permit
Section of Vital Statistics Registration Permit No_
NAME OF DECEASED DATE OF DEATH DEATH COMMUNICABLET
Clarence P. Wessen I ::ay 1; 1976 I ❑ T- ® N.
SEXI AGE PLACE OF DEATH (C1ty Vine orTerWy) (Cwty)
Vale 73 Chaska, Carver
METHOD OF DISPOSAL: PLACE OF DISPOSITION (Nue of eso4ty or -w 6� ) (City. Village or TowrtlF, Cwty. S44)
BURIAL CREMATION Chanhassen Cemetery
REMOVAL OTHER (gedfs) Carver County, Minnesota
BIGNA RE OF NOETIC R FUNERAL OR BUSINESS DRESS
Zanjahn-Bertas Faun ral Hosie Third & Pine Chaska, Mn.
A ooRflea4 N drtb hA.4r beth Mod - rpalrM by 4w, pe.looI- 1. berNT slr 4 myw of Ihl, body.
GNATUEE OF REGISTRAR (City. (Cwty) IDATE ISSUED
�YaWs,
Carver 5_15_76
8I URE OP 'SON IN CHARGE OF CONVEYANCE
AUTHORIZED DISPOSITION AS STATEDI SIGNATURE OF SEXTON OE CEMETERY OFFICIAL I DATE RECEIVED
ABOVE OCCURRED ON: (M4�