Disposition Permit DISPOSITION PERMIT
DECEDENT'S NAME GARY LEE VADNAIS
GENDER MALE
DATE OF BIRTH /AGE 08/15/1953 / 67
DATE OF DEATH 04/05/2021
RESIDENCE
PLACE OF DEATH 902 HERSEY STREET
SAINT PAUL, RAMSEY, MINNESOTA
FUNERAL DIRECTOR JAMES J WHITE M3214
WHITE FUNERAL HOME / LIC # 0927
FUNERAL HOME OR 14560 PENNOCK AVENUE
OTHER ENTITY APPLE VALLEY MINNESOTA
PLACE OF DISPOSITION CEMETERY
PIONEER CEMETERY
CHANHASSEN CARVER MINNESOTA
m According to Minnesota Statutes. section 149A.93, subdivision 3.
section 144.221, and Minnesota Rules, part 4601.1500, the fact of
DEPARTMENT death has been filed with the Office of Vital Records.
OF HEALTH
Molly Mulcahy Crawford
STATE REGISTRAR
DISPOSITION PERMIT ISSUE DATE 04/08/2021 04:16 PM
(SIGNATURE OF FINAL DIS SITION FACILITY OFFICIAL)
--K i y-y-) ' \ -. t-it-euk \A)\ --:_),3 t-' i.\
(PRINT NAME OF FINAL DISPOSITION FACILITY OFFICIAL)
Rev 12/2013
SCANNED