Crandell, John 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 January 26, 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
John Bradshaw Crandell name war World War I
who died at Madison, Connecticut on January 25, 1966
Date of Birth Age(in years If under 1 year If under I day
June 14, 1896 last birthday)
Months Days Hours Mins.
69 Sex Male Race or Color White
Cause of death Anemia - Carcinoma of Stomach
for Burial in Pine View Cemetery in Glens Falls, New York
(Name of Cemetery) (Town) (State)
Fun. Dir.
Issued to Stillman A. Swan or Address Clinton, Connecticut
Embalmer
Embalmer's License No. 1190
W• �L
As1.t'. Registrar of Vital Statistics
THIS IS NOT A CREMATION PERMIT
Town of Madison, Connecticut.
Form 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 palter (VS 10) must also be attached to the box.
3. This burial permit must be given to the persor, 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
,',,' - ‘G G The body for which this permit was issued was buried.
L ( Cemetery on .:1'" . / 19..Lam..cc-
Sexton