Markoff, Anna STATE OF VERMONT DEPARTMENT OF HEALTH Division of Vital Statistics
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BURIAL--TRANSIT PERMIT Burial Permit No / 1....
Full name of deceased .../ s.._.,, .::Jt.. .,_._ I /�2_,../J �.. . ,../ / _....__....
Place of death L .�.. ...1....e......IA( _..........._....,� .4.t.../"<.. 4k..e/ k� t_' ,'' /`'Z6
2 / (1`own or ity) _ (County �- (State)
o Date of death '\./C..N e /7 19. ..Color <?.4, t ' Sex..I..e.c—/.a/e Age cam/ _......_................
re E
o z �. Method of dispos I )
/" ' .! a/..0 F.c.elf ( e e.t S�Ie/lic e 27=r. .
m _Y c fo3ial, Cr lion, Tra�' Storage, etc.) (Cemetery or Cremato (Town) (St re = °-o Funeral Director) ' : mt.z.,-.1/s..�.:..t'• 'C Address .€..,1' , .G..a.e... 1, V, m
zaZZ § ` PERMIT -
o a�
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t9 m° if. A- rtificate pf death havlpg been file s required by the laws of the State of Vermont, permission is hereby given to
A ~= ze 0--... „ 7, .2: �/ to dispose of the body as above stated.
3 E — uneral D�ii fo_r/or Person Actin as Such)in ry
a Dated at..........g...%:../1..e....I`.G'... this •/7 of 1/4.e...,l..i ..G` 19 S 6
(Clerk's Address) ' rr \\
i`- Signature /day
l `-C-----s-- --1
(Town or City lerk)
METERY OR CREMATORY AUTHORITY SHALL FILL OUT SPACE BELOW
Body was �-�"''� on S�. '"'� I l 19�-4 in ....
(Cremat ''gd, Stored, etc.) [! / ( emet ematory)
Place... :. r ` to V Signature 3- l(Sexton or Personn in Charge)
SEE OTHER SIDE
READ CAREFULLY
TOWN OR CITY CLERK; This burial-transit permit may be issued only upon receipt of a death certificate. In spe-
cia► 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 dispo-
sition 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 cer-
tified, according to the provisions of Section 272, Vermont Statutes, Revision of 1951.
PENALTY for violation is not more than $500 or less than $20.
DH-35-8M-53