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Disposition PermitDISPOSITION PERMIT DECEDENT'S NAME PHYLLIS LORRAINE JOHNSON AKA/ PENNY L JOHNSON GENDER FEMALE DATE OF BIRTH /AGE 10/28/1921 / 93 DATE OF DEATH 01/03/2015 RESIDENCE PLACE OF DEATH 4916 WOODHILL ROAD MINNETONKA, HENNEPIN, MINNESOTA FUNERAL DIRECTOR DEAN C HEINS M3847 HUBER FUNERAL HOME & CREMATION / LIC # 0759 FUNERAL HOME OR 1801 COMMERCE BOULEVARD OTHER ENTITY MOUND MINNESOTA DISPOSITION FACILITY FAIRVIEW CEMETERY ASSOCIATION MINNETRISTA MINNESOTA PLACE OF DISPOSITION CEMETERY PIONEER CEMETERY CHANHASSEN CARVER 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 Vital Records. rX flu l Molly Mulcahy Crawford STATE REGISTRAR DISPOSITION PERMIT ISSUE DATE 01/04/2015 03:47 PM j1 �c _ OF FINAL DISPOSITION FACILITY OFFICIAL) (PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL) Rev 12/2013