Daggs, Ruth iURIAL TRANSIT REMOVAL PERMIT PERMIT
O. DATE ISSUED
S-9 Rev. 2/09 STATE OF CONNECTICUT 0 24/ 21
DEPARTMENT OF PUBLft;HE.kLTf;3
HARTFORD,CT 06134-0308 2%
This permit is sufficient for the removal of a body to any town and also for interment. It must accompany the body and be given to the person in charge of the cemetery.
This permit is NOT sufficient to cremate a body.A Cremation Permit(VS-48)must also be obtained in addition to this permit.
The sexton must endorse this permit and return it to the registrar of the town where the cemetery is located.The sexton must also forward a copy of this permit to the town where
death occurred if different from the town of burial. If the body is cremated,the person in charge of the crematory must return this burial permit to the town where death occurred.
ERMISSION IS GRANTED TO REMOVE/TRANSPORT/BURY THE BODY OF WHO DIED AT (Institution Name and Town of Death) ON
Ruth Daggs t 9R South Rd, Enfield CT 03/ 23 / 21
AUSE OF DEATH
Pancreatic Cancer
EMPORARY DISPOSITION(LOCATION,ADDRESS,CITY,STATE AND TELEPHONE NUMBER)If body placed in receiving vault,give date.
NAL DISPOSITION(Name and address of cemetery or crematory)
Pine Vievy Cemetery, Oeensbury NY
URIAL PLOT SECTION NO. LOT NO. I GRAVE NO. I OTHER PLACE OF INTERMENT(Specify)
SUED TO(Name of Funeral Director or Embalmer) ADDRESS IF EMBALMER,LICENSE NO.
Kevin Davidson / Hartford Trade 673 Main St, Fast Hartford 2698
?rtificates required by state statute have been SIG (Registrar of Vi araatistics) TOWN OF TRANSIT PASTER
ceived and recorded.Body has been prepared -
accordance with the Public Health Code. 0L" Iatm FAct_Hartford E YES ❑ NO
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THE BODY FOR WHIC IS PER ^V As ISSUED WAS BURIED IN ABOVE NAMED DATE BODY BURIED
SEXTON'S ENDORSEMENT CEMETERY(Sexton's Signature)
4 . •
Public Health Law Sec. 4145(2b) 0 1 4 E 8 6
Receipt
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•Human remains of , delivered on / , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#