Burial PermitCgRi4vC 79- ;l---
Burial - Removal - Transit Permft PA„nN Nn _Q.51
NAME OF DECEASED
DATE OF DEATHCOMMUNICABLE?
DEATH
Mae Irene Ernst
May 13, 2001
❑`'lis
EDNO
SEX AGE
PLACE OF DEATH IOTD-, VILLAGE OR TOYMSHPI
IOOUNTYI
Female 1 82
Spring Park
Hennepin
METHOD OF DISPOSAL
PLACE OF DISPOSITION (NAME OF CEMETERY OR CREMATORY) (CITY,
VILLAGE OR TOWNSHIP, COUNTY.
STATEI
OBURIAL ❑CREMATION
Pioneer Cemetery
REMOVAL ❑ OTHERISPECIFY)
Chanhassen, Carver ,MN
SIGNAT RE OF RTIC OR FUNERAL DIRECTOR
BUSINESS ADDRESS
1801 Commerce Boulevard Mound MN
55364-
c ific a of death having been filed as required by law, permission is hereby given to dispose of this body.
SIGNATU F REGI (CITY. VILLAGE OR TOMSHIP1 (cO
ITRLEI
DATE ISSUED
Mound Hennepin
Sub -Registrar
05/15/01
SIGIATUR PER96WACHAIlIM OF CONVEYANCE
AUTHORIZED DISPOSITION
SIG URE OF B O EMETERY OFF IAL
DATE RECEIVED
AS STATED ABOVE May 16, 2001
-t��C-i
OCCURRED ON :(DATE) Y
HE -00113-03 (7184) / V
Original—Place of Disposition Copy—Sub Regislra