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Burial Permit
STATE OF MINNESOTA �\ o- t a ! 5- DEPARTMENT OF HEALTH Burial - Removal - Transit Permit 4944 Section of Vital Statistics Permit No NAME OF DECEASED DATE OF DEATH DEATH msCOMKUNICABLE?R William Williamson 9-1%1%5 1:1 T" 13 N. 8SE AGB PLACE OF illa, DEATH (City V.., Tow..bio) (Coaaty) hale 88 Yrs. Minneapolis Henn. METHOD OF DISPOSAL: PLACE OF DISPOSITION (N.. of as.teq or �tory) (City. VIBa,..r T.wmhi,, Ceaaty. Stat.) © BURIAL CBBHATION BEH eL OTHER (oFSH,) Chanhassen Twp. Cemetery Carver Cty. Minn. SIGNA ! i HORTI J DIRECTOR BUSINESS ADDRESS / z I 520 -2nd. St... Excelsior, Minn. I A artlfirau a firth b..ins bee. fi1.d a r Wd d by Lw, p.rmL.ion I. hereby aloe• t. dh;P .f Od, body. A _ REdISTBAR- (City. vubl .r T. ... M,) (C.ob) I DATE ISSUED SIGNATURR OF PERSON IN -CHARGE OF AUTHORIZED DISPOSITION AS STATED SIGNATURE OF SEXTON OR CEMETERY OFFICIAL_- I DATE RECEIVED B AOVE OCCURRED ON: (Daft) 6-11-63 7M SKS Order Na.85280