Plude, Douglas 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) �
No.of permit dZ 7�+2
3
Date December 22, 1975
The certificates required by 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
Douglas G. Plude f,a;e war No
who died at Norwalk Hospital, Norwalk, Conn. on December 21, 1975
Date of Birth Age(in years If under I year If under I day
July 12th, last birthday) Monte Days Hours Mina.
1903 72 Sex ale Race or Color White
Cause of death Duodenal Ulcer-6 Perforation, Obstruction & Bleeding
Tello�rary: St Al h ns Queensbury, New York
for m Recei�{ of M Cemetery in
fit C�Bt Y (Town) (State)
Raymond Funeral Home, Inc Fun. Dir. 5 East Wall St. ,Norwalk Conn.
Issued to or Address
1853 Embalmer
Embalmer's License No.
Registrar of Vi latish s
THIS IS NOT A CREMATION PERMIT Norwa k, Conn.
Town of
Form V. S. 9