Burial PermitBurial -Removal -Transit Permit Permit
NAME OF DECEASED
DATE OF DEATH
DEATH COMMUNICAELE7
Ida -E. Olson
1 9-11-90
[_1 Yea n..
SEX AGE
PLACE DF DEATH JDRY, WI GE OR TOMMSMIP) (COYMY)
Female 100
Waconia Carver
METHOD OF DISPOSAL:
PLACE OF DISPOSITION (NAME OF CEMETERY OR CREMATORY) (CRY, VILLAGE OR TORI ISHIP, CWNfY, TIRE)
® BURIAL ❑ CREMATION
F] REMOVAL ❑ OIHER(lPECIFY)
(�r�.��}�.�
Chanhassen Pioneer Cemetery Chanhassen, Carver, Mn.
GN RR
OF MORCI O
DIRECTOR
EUSI NESS ADDRESS
—
F/A
Paul Funeral Home 218 W. Hill St. Norwood, Mn. 55368
certificate of death h"'
g been filed as required by law, permission is hereby given to dispose of this body.
SJGN OF REGISTRAR
lcow. vlWGE OR =wRzHIP) (CWRiY)(TYLE
DAT£ ISSU D
Norwood Carver Sub—reg.
9-14-90
1
sic ERSON CHOJ`TH
COJNVEYANCE
ORIZED DISPOSITION
SIGNATLRE OF SEXTON OR CEMETERY OFFICIAL
DATE RECEIVED
S STATED ABOVE
OCCURRED ON: (GATE)
HE -00113-03 (7/84)
This form provided by the Minnesota Department of Health, Section of Vital Statistics Original—Place of Disposition Copy—Sub Registrar