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Disposition PermitDISPOSITION PERMIT DECEDENT'S NAME WAYNE HERBERT THOMPSON DECEDENT'S ALIAS WAYNE H. THOMPSON SEX MALE DATE OF BIRTH / AGE DECEMBER 11, 1931 / 76 YEARS DATE OF DEATH DECEMBER 16, 2007 PLACE OF DEATH GOLDEN LIVING CENTER - ST. LOUIS PARK 3201 VIRGINIA AVE SO SAINT LOUIS PARK, MINNESOTA HENNEPIN FUNERAL DIRECTOR M3058 WALLY GELECINSKYJ FUNERAL HOME 0144 HUBER FUNERAL HOME & CREMATION SERVICE 520 SECOND STREET EXCELSIOR, MINNESOTA 55331 PLACE OF DISPOSITION CHANHASSEN PIONEER CEMETERY CHANHASSEN, MINNESOTA According to Minnesota Statutes, section 149A.93, subdivision 3, section 144.221, and Minnesota Rules, part 4601.1500, the fact of death has been filed with the Office of the State Registrar. 5;11:1 - £Qtl..,...: Steve Elkins State Registrar Authorized Disposition Occurred on: Signature of Crematory or Cemetery Official: (type or print name of crematory or cemetery official)