Taylor, Elizabeth Ann ,411
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH I i o
BURIAL-TRANSIT PERMIT Permit No. ' "�
Permit for Removal, Disinterment and Reinterment
•
1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Elizabeth Ann Taylor Female September 13,2006
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Fair Haven,Vermont June 19,1931 Colchester,Vermont
7. Name and Address of Funeral Director or Authorized Person
James C. Aubin,Durfee Funeral Home 119 North Main St. .Fair Haven.Vermont 05743
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
E Temporary ❑Removal fromemation E Burial or
Storage 111
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/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 City/Town, State Date
Pine View Crematory Queensbury New York Sept.14,2006
0 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
nature of Jerk or Deputy City/Town a ate
1 ignature of Crematorium Official Container Number Date
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery City/Town Date
0 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
Body/Cremains were ❑Buried ❑Entombed Date
Name of Cemetery Section Lot Number Grave Number
City/Town, State Signatu�,pi Sexton/Ce t�al
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)