Whipple, Frank Always write with black ink.
CONNECTICUT STATE DEPARTMENT OF HEALTH
Hartford, Connecticut, U. S. A.
REMOVAL, TRANSIT AND BURIAL PERMIT
(This permit is sufficient for removal of a body to any town and also for interment) r
tic36
No.of permit
Date Nov. 1 , 1974
The certificates required (zy'the state statutes have been received and recorded, that the body has been prepared in accordance with the Public Health Code.
Permission is granted to remove the body of
If veteran
Frank Augustus Whipple name war No
who died at Hartford Hospital on Oct. 30, 1974
Date of Birth Age(in years If under I year If under I day
last birthday) Months Days Hours Mors.
12-7-1890 83 Sex Male Race or Color white
Cause of death Cardio renal failure
for Burial in Pine View Cemeteryia Glens Falls, New York
(Name of Cemetery) (Town) (State)
Fun. Dir.
Issued to Newkirk & Whitney or Address West Hartford, Ct.
Embalmer
Embalmer's License No. 1 686
e.4€41111.444.1
egistrar of Vital Statistics
THIS IS NOT A CREMATION PERMIT Asst.
Town Hartford
Form V. S. 9