Whipple, Adela REMOVAL, TRANSIT, AND BURIAL PERMIT PERMIT NO. DATE ISSUED
VS-9 REV. 10-74
CONNECTICUT STATE DEPARTMENT OF HEALTH 10 /4 /77
HARTFORD, CONNECTICUT 06115
1. THIS PERMIT: a. Is sufficient for the removal of a body to any 2. THIS IS NOT a permit to cremate. For that, a Cremation Permit
town and also for interment; b. must accompany body, and c. must (VS-48) must be obtained in addition to this permit.
be given to person in charge of cemetery and endorsed at bottom by the 3. IF TRANSPORTING BODY across town limit this permit must be
sexton who must then forward it to the registrar of the town where the completed in duplicate and the copy designated "Transit Paster" must be
cemetery is located. attached to coffin.
PERMISSION IS GRANTED TO REMOVE/TRANSPORT/BURY THE BODY OF WHO DIED AT ON
ADELA COLVIN WHIPPLE WINDSOR, CONN. 10 / 1 / 7'
CAUSE OF DEATH -
SEPSIS `
TEMPORARY DISPOSITION (If body placed in receiving vault,give date.)
FINAL DISPOSITION (Name and address of cemetery or crematory)
Entombment Pine View Glens Falls , New York
ISSUED TO (Name of Funeral Director or Embalmer) (Address) (If embalmer,
Newkirk & Whitney Inc. 776 Farmington Ave._. West Hartford, Conn. /jc91o1)
Certificates required by state statute SIGNED (Registrar of Vital Statistics) (Town of) TRANSIT PASTE
have been received and recorded. % A S rt
Body has been prepared in accordance i WINDSOR n n
with the Public Health Code.
THE BODY FO:V1ZCH HI P MIT WAS WAS BURIED IN ABOVE NAMED DATE BODY BURIEI
SEXTON'S ENDORSEMENT CEMETERY (Sexton's /, �� /41 / -
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Signature! L(