Durfee, Martha DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
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
Martha Langdon Durfee Female January 14,2006
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland,Vermont July 13, 1920 Rutland,Vermont
7 Name and Address of Funeral Director or Authorized Person
James C. Aubin;Durfee Funeral Home 119 North Main St.Fair Haven.VErmont 0574'3 ,
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
❑Temporary E Removal from Xigrmation ❑Burial or
III Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment
(Section B) (Section D)
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 Jan. 17,2006
40 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
ignature of Jerk or Deputy City/T�� Date
i nature of Crematorium Official Container Number Date
AeLL fro- t.,1 ----- 7 1,_' 7 - 0
SECTION D: (Complete this section if body(cremains will be buried or entombed.)
Name of Cemetery City/Town Date
1111 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)