O'Rourke, Marjorie REMOVAL, TRANSIT, AND BURIAL PERMIT
VS-9 REV. 3/94 STATE OF CONNECTICUT PERMIT NO. DATE ISSUED
DEPARTMENT OF PUBLIC HEALTH AND ADDICTION SERVICES --- 3 /17 / 99
HARTFORD, CONNECTICUT 06106
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
sexton who must then forward it to the registrar of the town where the
cemetery is located.
PERMISSION IS GRANTED TO REMOVE/TRANSPORT/BURY THE BODY OF WHO DIED AT ON
Marjorie F. O' Rourke East Windsor 3 /16 / 99
CAUSE OF DEATH
Athensclenotic Cariovascular Disease
TEMPORARY DISPOSITION(If body placed in receiving vault, give date.)
FINAL DISPOSITION(Name and address of cemetery or crematory)
Pineview Cemetery - Queensbury, New York
ISSUED TO(Name of Funeral Director or Embalmer) (Address) (If embalmer,
Newkirk & Whitney 318 Burnside Avenue, East Hartford lic. no.) 2254
Certificates required by state statute SIG _ (Registrar of Vital States s) (Town of) TRANSIT PASTER
have been received and recorded.
Body has been prepared in accordance (0 East Windsor
with the Public Health Code.
BODY FOR WHICH PERM AS IS UED WAS BURIED IN ABOVE NAMED DATE BODY BURIED
SEXTON'S ENDORSEMENT EMETERY(Sexton's Signature) .AAl 9J 1 i e-oi1„ c��j 3 /A0/??r