Burial PermitBurial - Removal - Transit Permit
Permit N . r a
Pamela Susan Rotgers
December 13, 1999
❑Yes X❑ NO
(CRY, VRIAGE OR TOWNSHIP)
Female
93
Chanhassen
Carver
I -ACE OF DISPOSITION PM OF CEMETERY OR CREMATORY)
1CITY, VILLAGE OR TOWNSHIP, COUNTY, STATE)
msufl . ❑CREMATION
Chanhassen Pioneer Cemetery
F-IRIEMOVAi. ❑OTHER(SPECIFY)
Chanhassen, Carver ,MN
_
Washburn McReavy Chapels -
EP
7625 Mitchell Road Eden Prairie MN
A certificate of dea having been filed as required by law, permission is hereby given to dispose of this body.
42
(CITY, VILLAGE OR TOWNSHIP) (COUNTY) (ITT EI
DATE lszueo
'nneapolis Hennepin Sub. Reg.
12/19/1999
AUTHORIZEDDISPOSITION
SIGNATOR OF SEXTON OR CEMETE OFFICIAL
DATE RECENED
ASSSTATED AABOVE
OCCURRED ON:IDATE) Dec 16, 1999
/;t - /
Original -Place o(Disposition Copy -Sub Registrar