Plude, Lou Ella DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH � �
3URIAL-TRANSIT PERMIT Permit No.
Per Removal, Disinterment and Reinterment
1) 1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Lou Ella Plude Female November 24,2006
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Fair Haven,Vermont July 11,1939 Johnson, Vermont
7. Name and Address of Funeral Director or Authorized Person
James C. Aubin; Durfee Funeral Home,Inc. ,119 North Main St,Fair Haven,VT 05743
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
SD Temporary ❑Removal from X (Serration ❑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/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 Crematorium Queensbury, New York0 Nov.27,2006
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
S. ature of Cl rk or Deputy City/Town, Date
(-'• GGG44 /`Q.fe - / , l/-C�+*D'1C?' /id�'cPSt0dd6_
ignatur of Cremator' m Official Container Number Date
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery City/Town410 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
Body/Cremains were ❑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)