Cameron, Edith klways write with Mack 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)
�J No. re
'lame of Demasded._�.c/ �//�l pp(r�!'Q7'r if Cat.of n...th f,(jy�. Qi/ iedi�,+___
kee. i yan--Q�_months J deys. S-er7%--�— Race or Coke /7 t`(/
:auea of Death(1) _ -/�►a (2)
kneading Phsiaas
'lace of Da h '�d� t?Lrt mbalmer ..717i Ne. CO L
Jodemkasge
The Certificate of death and the undertakers statement having been recorded that the body has been prepared for removal or burial
n accordance with the state statutes and sanitary code,
THIS CERTIFICATE is utbority for REMOVAL.
FROM TO
FROM - P- �^'��- ---- --. .- TO
V' _ - 1 L-_-_ _ Dated Shipment ..__
Ontetuy m `�.4.tee.444: 4//�.-- State—as/4
—DateJ/.�c+/ 1" _ ___ *e Regina'of �/7 (! IQ /
(This permit not legal for burial in town when. person died)
4 V S
i
vV ( �
1f cne body does not leave the town in which death occurred a white permit
for burial only is required.
'�' ` f 7.1 \
If the body is removed outside the limits of the tow) in which death occurred
(�� a remove' and burial permit is required.
A temporary removal permit is good for only 24 hours.
J j
The burial permit is given to the person in charge of the cemetery.
`C`` ', The removal permit accompanies the body and if trsnaportntion is by common
carnet' a transit pastel- also must be attached to the box.
.41 ry If a body is removed from town where death occurred for OVER 24 HOURS-
‘ .4)
\\. a. This type of removal permit must be obtained.
b. If burial is in town where death occurred a regular white burial permit must
).14) )41
\)\,,k.s3
be
secured in addition to this permit.
c. If burial is in a town other than where death occurred, this permit is au
thority for burial in the oemetery named in the face hereof.