Fisher, Richard STATE OF VERMONT DEPARTMENT OF HEALTH Division of Vital Statistics
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BURIAL--TRANSIT PERMIT Burial Permit No _._..._.„_..—_
a Full name of deceased ....:J_D ar„11„_ r l R h e Y'
a
.I'2 Place of death..._.__ M. ' T' „Xy'r1.'_ „ RISC lajid _._ _. Vim 0 n t _
0 a (Town..a.City) (County) (State)
= g Date of death ..M£d..y 3n___ .„_� __. _.._ _..__19.__5A. Color__._„.}1i '..8._ _. _ Sex....4'45.,1,.e.._.. _.__.. __Age_.__27
WF A T(Yr., Mo., Da.)
> 3�' 1Method of disposal Burial We S t„Li�„�r'Il_ �,. . C P..X' t E'.T'J,_,�zl ens "la 11�I aE,v
a Z a 0 (Burial_Cremjation,Transit, Storage,etc.) (Cemetery or Crematory) (Town) (State)
Isla a" c° Funeral Director __.._.......!j nh n b14t C -e.nuo t t _._..._..._ ._._._... Address...... 'a j..Z.....Ka.Y„f'n.; V..t_...„.._ „.„.__„_..._�
Wcil zzzua PERMIT
cdozz�Q� e
„ .. i A A certificate of death having been filed as required by the laws of the State of Vermont, permission is hereby given to ..._....__..__
OG ........m....T.91444....12,....m... ....tt, to dispose of the bodyas above stated.
4 it_: (Funeral Director or Person Acting as Such)
2 a E Dated at Fa.„ .Iw„. a V en , V t this 3�1. 3_ „„.„. _ day of ___!9 S 4
3 d (Clerk's Address)
� RL
`" Signature._ -T-
_ „ _. (Town or- sy Clerk)
F F
CEMETERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE B LOB
Body was .._._. `r,:� _..._....._ on „„ „. °� 19.1_7.._ in�d raW-4 1c�l�G
(Cremated, Buried, Stored,etc.) v � .„.......„_ _. (Cemetery or Crematory)
c
Place _ „...._........_......_........._....„... „.... Signature . ...... . '��
{Sexton or Person in arge)
READ CAREFULLY
TOWN OR CITY CLERK: This burial-transit permit may be issued only upon receipt of a death
certificate. In special emergencies, telephone the Department of Health for instructions.
FUNERAL DIRECTORS: The burial-transit permit is required for any manner of disposition of a
dead body including interment, storage, cremation and transportation. A permit is required for each
stillbirth before disposal of the body.
When used as a transit permit for transportation by common carrier, this permit or a duplicate thereof
should be enclosed in a strong envelope and attached to the shipping case. A separate permit is required
for disinterment and reinterment.
SEXTON: It is unlawful for any sexton, or other person in charge of a burial place, to permit burial
or other disposition of a dead body before a burial-transit permit is deposited with him. (The sexton may
accept the permit of any state or of the District of Columbia as authorization for burial.)
All permits must be delivered to the clerk of the town in which the cemetery, tomb or vault is located,
properly certified, according to the provisions of Section 4152, Vermont Statutes, Revision of 1947.
PENALTY for violation is not more than $500 or less than $20. \ft. ,
DH-35.20M-4.50