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Disposition PermitDISPOSITION PERMIT DECEDENT'S NAME GERALD EMMETT BOUCHER DECEDENT'S ALIAS SEX MALE DATE OF BIRTH / AGE JANUARY 27, 1940 1 67 YEARS DATE OF DEATH OCTOBER 25, 2007 PLACE OF DEATH CABIN 6156 BOTTOM BOUNCER LANE NE REMER, MINNESOTA CASS FUNERAL DIRECTOR M2122 MICHAEL J ST. AUBIN FUNERAL HOME 0956 WASHBURN-MC REAVY EDEN PRAIRIE CHAPEL 7625 MITCHELL ROAD EDEN PRAIRIE, MINNESOTA 55344 PLACE OF DISPOSITION 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. Steve Elkins State Registrar Authorized Disposition Occurred on: �� ti-� v Z %, foo 7 Signature of Crematory or Cemete k16lre('N T_ Eki1�11(--Ihi+rdt�J or print name of crematory or cemetery