Richetts, Mary 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
Date March 24, 1966
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
If veteran
Mary Rj cketts _ name war No
who died at Saint Josephta Manor __—_ on March 23rd, 1966
Date of Birth Age(in years j If under f year if under I day
/ 5� 7 last birthday)
2 1 188 ,79 Months Days Hours Muu.
Female
Sex ace or Color 'White
Cause of death CO2 Narcosis
for Burial in Pine view _Cemetery in Glen Falls, New York
(Name of Cemetery) (Town) (State)
Fun. Dir.
Issued to Len J. Redg . h cr Address 1297 Park Ave. Rpt_, Conn_
Embalmer
Embalmer's License No. 1300
Reuistra:of Vital Statistics
THIS IS NOT A CREMATION PERMIT
Town of Trumbull
corm v. s. 9
NOTICE
1. No body may be buried without a permit from the registrar of the town in
which the person died.
2. The permit accompanies the body. If transportation is by common carrier,
a transit paster (VS 10) must also be attached to the box.
3. This burial permit must be given to the person in charge of the cemetery.
The sexton of the cemetery is required to endorse this permit with the date and place
of interment and forward it to the registrar of the town in which,the cemetery is
located.
4. A temporary permit (VS 26) is good for only 24 hours.
5. If the body is to be cremated, a cremation permit (VS 48) must be obtained
in addition to this permit.
SEXTON'S ENDORSEMENT
The body for which this permit was issued was buried
1 Cc.t/ ,�2 �5
in 171—�-G!„�w,.... Cemetery on 19..4..
C
•
Sexton