DeFrancisco, John DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
410 1. Decedent's Name (first, middle, last) 2. Sex 3. Date of Death
John Eugene DeFrancisco Male April 30,2006
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Burlington,Vermont December 8,1934 Rutland,Vermont
7. Name and Address of Funeral Director or Authorized Person
.i mpc Aubin:Durfee Funeral Home,119 North Main St. ,Fair Haven,Vt. 05743
PERMISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from „ jtemation ❑Burial or
1111 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 May 2, 2006
0 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Signature of Cler. or Deputy City/Town Date
IA i ,�cL�j Burlington,Vermont May 2, 2006
zrgnature of Crematorium Official &F Container Number Date
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery City/Town Date
ilioPERMISSION 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,9f Sexton/C etery Official
This permit is to be filed with the City/Town Clerk by the 10th day of the L/month following disposition. (Title 18, V.S.A. 5215)