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Disposition Permit DISPOSITION PERMIT DECEDENT'S NAME ROBERT WALTER SCHWARTZ GENDER MALE DATE OF BIRTH /AGE 01/21/1939 / 80 DATE OF DEATH 01/08/2020 RESIDENCE PLACE OF DEATH 50 RILEY CURVE CHANHASSEN, HENNEPIN, MINNESOTA FUNERAL DIRECTOR TODD E SULLWOLD M3106 HUBER FUNERAL HOME & CREMATION / LIC # 0144 FUNERAL HOME OR 520 SECOND STREET OTHER ENTITY EXCELSIOR MINNESOTA PLACE OF DISPOSITION CEMETERY PIONEER CEMETERY CHANHASSEN CARVER MINNESOTA ■ r N 1. s o r a According to Minnesota Statutes, section 149A.93, subdivision 3, MIHsection 144.221, and Minnesota Rules, part 4601.1500, the fact of Era r r cry death has been filed with the Office of Vital Records. Molly Mulcahy Crawford STATE REGISTRAR DISPOSITION PERMIT/ISSUE DATE 01/10/2020 11:54 AM 49A v (SIGNATURE OF FINAL DISPOSITION FACILITY OFFICIAL) (PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL) Rev 12/2013