Zingerman, Patrick 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, 1967
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
PATRICK ZINGERMAN If veteran NO
name war
who dies at STAMFORD HOSPITAL, STAMFORD, CONN. on MARCH 23, 1967
Date of Birth Age(in years If under 1 year If under 1 day
last birthday) —
Months Days Hours Mins.
3/27/1889 77 SexMALE Race or Color WHIM
Cause of death PULMONARY EDEMA
for Burial in PINE VIEW Cemetery in QUELNSBURY, NEW YORK
(Name of Cemetery) (Town) (State)
LEO P. GALLAGHER & SON 'Neu' Dir. STAMFORD CONNECTICUT
Issued to or Address
Embalmer
Embalmer's License No. 1735 ce Q.
e.
Registrar of Vital Statistics
THIS IS NOT A CREMATION PERMIT
STAMFORD
Town of
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 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
in ...47'12'4..c. e Cemeter .on 194./
i',.=�••1.�.�: , ti r i� '2 24
�, 7� Sexton