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Disposition Permit
RECEIVED DISPOSITION PERMIT JUN 24 2020 DECEDENT'S NAME ANDREW PIKE CITY OF CHANHASSEN GENDER MALE DATE OF BIRTH /AGE 10/03/1979 /40 DATE OF DEATH 06/16/2020 RESIDENCE PLACE OF DEATH 4482 BULRUSH BLVD SHAKOPEE, SCOTT, MINNESOTA FUNERAL DIRECTOR TODD A JOHNSON M3095 JOHNSON FUNERAL HOME / LIC # 0141 FUNERAL HOME OR 141 EAST FIRST STREET OTHER ENTITY WACONIA MINNESOTA PLACE OF DISPOSITION CEMETERY PIONEER CEMETERY CHANHASSEN CARVER MINNESOTA MINNESOTA According to Minnesota Statutes, section 149A.93, subdivision 3, !� section 144.221, and Minnesota Rules, part 4601.1500, the fact of oErAwTMEwT©,wEUTw death has been filed with the Office of Vital Records. 6+1 Molly Mulcahy Crawford STATE REGISTRAR DISPOSITION PERMIT ISSUE DATE 06/17/2020 11:15 AM (SIGNATURE OF FINAL DISPOSITION FACILITY OFFICIAL) t r. vv�CA.k.A1 e (PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL) Rev 12/2013