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Disposition PermitDISPOSITION PERMIT R'fEliv 11116 1.2 f� DECEDENT'S NAME WALTER JALMER JOHNSON JR Qp <UU8 CHANH4S DECEDENT'S ALIAS WALTER J. JOHNSON SEX MALE DATE OF BIRTH / AGE SEPTEMBER 05, 1919 / 88 YEARS DATE OF DEATH AUGUST 09, 2008 PLACE OF DEATH 4916 WOODHILL ROAD MINNETONKA, 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. Steve Elkins State Registrar Authorized Disposition Occurred on: Signature of Crematory or Cemetery Official or print name of crematory or cemetery official) /3,_-)o0o'