Bruso, Jean /o /
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
BURIAL-TRANSIT PERM Permit No.
Permit for Removal, Disinterment and Reintc-knent
.,
• 1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Jean Elizabeth Bruso Female February 22,2006
4. City/TowR of Death 5. Date of Birth 6. Place of Birth
Rutland, Vermont March 6,1930 Fair Haven,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)
❑Temporary E Removal from cremation ❑Burial or
O 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 Crematory Queensbury,Vermont Feb. 24,2006
0 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
nature ofperk or Deputy City/Tow ate
-1,6,Af-C-ateki "" ,i)--", ,,Cee,14-heil, 14-eweez, t-44.4/,aleef 6.,
ignature of Crematorium Official Container Number Date
"eta ,'O l 2-2 Y 0
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 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)