Edwards, John LH
PERMIT MUST ACCOMPANY REM NS TO DESTINATION
FORM BT-1,1/96
STATE OF NEW HAMPSHIRE 1.BURIAL PERMIT NO
2.CITY OR TOWN
BURIAL TRANSIT PERMIT
3.DECEDENT'S NAME(First,Middle,Last) 4.SEX 5.DATE OF DEATH(Month,Day,Year)
JOHN R EDWARDS MALE SEPTEMBER 28,2006
6.AGE 7.DATE OF BIRTH(Month,Day,Year) 8.CITY,TOWN,OR LOCATION OF DEATH 9.COUNTY OF DEATH
71 Years APRIL 24,1935 LEBANON GRAFTON
10.METHOD OF DISPOSITION: 11.PLACE OF DISPOSITION(Name of cemetery, 12.LOCATION 13.DATE OF DISPOSITION
1. Burial 2.Temp.Entombment crematory or other place) (City/Town,State) (Refer to 19a)
3. Cremation 4. Donation PINE VIEW CEMETERY QUEENSBURY,NY OCTOBER 03,2006
5. Mausoleum 6. Other
14.IF ENTOMBED(OR CREMATED)PLACE OF FINAL BURIAL 15.LOCATION(City/Town,State)
CODE: 3
16.FUNERAL DIRECTOR 17.N.H.LIC.NO ONLY 18.NAME AND LOCATION OF FACILITY(City/Town,State)
TODD J VALENTU 000 ROBERTS-AUBIN FUNERAL HOME,POULTNEY,VT
19.COUNTERSIGNED AGENT(CITY BOARD OF 20.CITY/TOWN 21.DATE ISSUED(Month,Day,Year)
HEALTH/SUB-REGISTER if arm.) LEBANON OCTOBER 02,2006
PEGGY LEVA
22.IF STORED,BODY WAS PLACED IN(Name of Storage Vault) 23.DATE STORED(Month,Day,Year) 24.CITY/TOWN,STATE
25.SIGNATURE OF SEXTON OR PERSON IN CHARGE OF STORAGE VAULT 26.DATE ISSUED(Month,Day,Year)
✓tr�a�m"o/?r„i, 2 _ *�D,,rz,✓/�. µ�„✓ el' v,.,.
27.TYPE OF DISPOSITION(Cremated,buried,etc.) 28.DATE OF DISPOSITION 29.NAME AND LOCATION OF CEMETERY OR
(Month.Day.Year) VAULT(City/Town.State)
Cr IC IC /LI /1)b Putty.t ,. Crc,r‘c.t or1JT
30.SECTION 31.GRAVE NO. 32.SIGNAT RE OF SEXTON OR PERSON IN CHARGE
This permit,after being signed by the Sexton or person in charge(or by the Funeral Director where there is no Sexton)must be forwarded within six days to
the clerk of the town in which the disposition takes place.