Disposition PermitDISPOSITION PERMIT
DECEDENT'S NAME
LOIS EVELYN WHITE
GENDER
FEMALE
DATE OF BIRTH /AGE
06/12/1920 / 96
DATE OF DEATH
02/16/2017
ELIM HOME
PLACE OF DEATH
409 JEFFERSON AVE S W BOX 638
WATERTOWN, CARVER, MINNESOTA
FUNERAL DIRECTOR
TODD E SULLWOLD M3106
BERTAS FUNERAL HOME & CREMATION / LIC # 0125
FUNERAL HOME OR
200 WEST THIRD STREET
OTHER ENTITY
CHASKA 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.
'" �tu" 64U4
Molly Mulcahy Crawford
STATE REGISTRAR
ITION PERMIT ISSUE DATE 02/17/2017 11:35 AM
(SIGNATURE OF FINAL DISp�JsmON FACILITY OFFICIAL)
(PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL)
Rev 12/2013
SLANNE