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