Mulholland, Genevieve ti
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH 2
BURIAL-TR4.NSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Genevieve I. Mulholland Female June 15, 2006
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland April 25, 1915 Swanton, Vermont
7. Name and Address of Funeral Director or Authorized Person
Jay T. Jillson 46 Williams Street Whitehall, New York 12887-
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
0 Temporary ❑Removal from IN Cremation 0 Burial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
SECTION A: (If temporary storage, complete this section.)
Place of Storage(Name of Cemetery or Vault) City/Town, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A.5201)
Signature of Clerk or Deputy City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION B: (If removal from temporary storage or disinterment, complete this section.)
Name of Cemetery or Vault from which body is being removed City/Town Date
Name of Cemetery where body is being taken City/i'own, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A.5201)
Signature of Clerk or Deputy City/Town , Date
Signature of Sexton/Cemetery Official Date
SECTION C: (Complete this section if botty=will bep erpatiad.)
Name of Crematorium City/Town, State Dat
Pineview Crematorium Queensbury NY 6,16/2006
PE: IISSION IS GIVEN TO DISPt"'SE O SAID ECU.' STF FED AEO'.,'=. (Title 1E, V.S.A.5201)
SiAlt ure of -S y �I City/Town ' Date
/' ��� C.-4 9�f .Rutland, Vermont 6/16/2006
Si f turfof Orel) torium Offic Container Number Date
rr 2 � 6/16/2006
SECTION D: (Complete this section if body/cremains IMII .e buried or entorlbed.)
Name of Cemetery City/Town Date
PERMISSION IS O,',/ N TO DISF'CSE ._s_ (T::le V.S.A.5201;
Signature of Clerk or Deputy ICityrrown Date
Body/Cremains were 0 Buried D Entoirbad Date
Name of Cemetery Section - Lot Number Grave Number
gg City/Town Signature of Sexton/Cemetery Official
This permit is to be filed with the City/Town Clerk by the 10th day of the month following disposition. (Title 18, V.S.A. 5215)