Burial PermitRu.121 _ ReMOVA . Transit Permit
P.m Mn
NAME OF DECEASED DATE OF DEATHDEATN COMMUNICABLE?
1999 1❑`'� Q MO
Philip Oscar Isaacson September 24,
SEX AGE PLACE OF DEATH (CRY, VILLAGE M TP SHIP) IcouxTR
Male 30 Eden Prairie Hennepin
METHOD OF DISPOSAL
PLACE OF DI WIION(NAME OF CEMETERY OR CREMATORY) (CRY, VILLAGE OR TOWNSHIP, COUNTY, STATE)
BURIAL nCREMATIDN
Pioneer Cemetery
MREMOVILL ❑OTHERVS CIFYI
, Carver ,MN
SIGNATURE OF MORTN7AH OR FUN DIRECTOR
BUSINESS ADDRESS
520 Second Street Excelsior MN 55331-
A certificate of death having been filed as required by law, permission is hereby given to dispose of this body.
SIGNATU OF REGISTRAR (CITY.Va1AGE OR TGyGMMIIPI NTYI (nTLE)
2 (ye s,
DATE ISSUED
7 Zi -f
SIGNATURE OF PERSON W CHARGE OF CONVEYANCE
AUTNORQED DISPOSRION
OFFICOL
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D�A�TE�RE�CE-N9ED
AosccsurARTREEDo AoBNoXvGEATEI Sept 29, 1999
HE-OM 13-03 (7184) / V v oHplmal—Place of Disposifim Copy—Sub Regwkar