Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Geddes, James
f DH-PHS-BTP-89a VERMONT DEPTMENT OF HEALTH Li s-a BURIAL-TRANSIT PERMIT Permit No. Permit for Removal, Disinterment and Reinterment 0 1. Decedent's Name(first, middle, last 2. Sex 3. Date of Death ��,,,•t-► e.3 e� s /%Je /© - 6-06. 4. Cit /Town of Death 5. Date of Birth 6. Place of Birth /1.1.1/0 v /D-/7-/ 9 A.o .sSa i C,, NOT 7. Name and Address_ off ugeral Directaor Authorizedut� Perspn ,�t (� /a 44/07 1,,c,lt�s/tfi` )o 1gox I /�l"./i'n t' , W- [/S LS 7 PERMISSION REQUESTED FOR: (Check only one box and complete apprd ate section) SE Temporary E Removal from f Cremation E Burial or Storage Temp. Storage or (Section C) Entombment (Section D) (Section A) Disinterment (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/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 C: (Complete this section if body will be cremated.) Name of Crematorium%. Ci !Town, State Date 7e, 1/P� Creona-oy Ns, tA{_ gle r io--it-0C 0 PERMISSION IS GIVEN TO DISPOSE OF Sb �eeH BODY AS STATED ABOVE. �w 18,V.S.A. 5201) S) nature of Clerk o Cit !Town J Date �g y -WCi.r� /6-/b -D >C Signature crematorium^-icial Container Number _ Date CIISa. ,o -((-. o6 SECTION D: (Complete this section if body/cremains will be buried or entombed.) Name of Cemetery City/Town Date PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201) 111/ Signature of Clerk or Deputy City/Town Date Body/Cremains were E Buried ❑ Entombed Date Name of Cemetery Section Lot Number Grave Number City/Town, State 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)