Brunelle, Arthur Always write with black ink.
CONNECTICUT STATE DEPARTMENT OF HEALTH
REMOVAL, TRANSIT AND BURIAL PERMIT
(Required for the removal of any deceased person or burial in town other than where death occurred)
No.
Name of Deceased rthu,r C. Brunelle Date of Death Jun a 5, 1935
Age, -53 _ years 10 _months 13 days. Sex bi al a Race or Color__. White
Cause of Death(1).Coronary Disease (2)_ Chronic MyooarditiL
Attending Physician HRtiry-l .__Gostello__ID _I ed,Bxtaa -_ 179 Allyn_ St. Hartf_ord,__Ccnn.
Place of Death].47-_Sheldon Street Embalmer GeQ_,__H Keyburn No.932
Undertaker Laraia & .S erino CO. —Address 190 Front St. Hartford, Conn
The Certificate of death and the undertaker's statement having been recorded that the body has been prepared for removal or burial
in accordance with the state statutes and sanitary code,
THIS CERTIFICATE is authority for REMOVAL.
FROM Hartford To Glen Fa118, New York
FROM TO
Via Baggage Date of Shipment June 6�1 935
Escort won-Cyri.11e _Brunelle_-_
and Burial in __- • Alphonse __ Cemetery in Sty Falls- - State__— New-York
Date June 6, 1935 Ass't. Registrar of Vital atistics
(This permit not legal for burial in town where person died)
Form 0-V.S.9 (7.34)10M
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If the body does not leave the town in which death occurred a white permit
or buriafAonly is required.
�` , If the body is removed outside the limits of the town in which death occurred
Ca removal and burial permit is required.
A temporary removal permit is good for only 24 hours.
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The burial permit is'given to the person in charge of the cemetery.
t ��\ ` The removal permit accompanies the body and if transportation is by common
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- carrier a transit paster also must be attached to the box.
If a body is removed from town where death occurred for OVER 24 HOURS:
i ; 1 a. This type of removal permit must be obtained.
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b. If burial is in town where death occurred a regular white burial permit must
be secured in addition to this permit.
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c. If burial is in a town of er than where.death occurred, this permit is au-
1 thority for burial in the cemetery named in the face hereof.
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