Markoff, Louis r OH-PHs-35.70 STATE OF VERMONT Permit No.
BURIAL-TRANSIT PERMIT
Permit for Disinterment, Transportation and Reinterment
Full name of deceased I Date of death
1. • 2. 8 _231_ 1
Color or Race Age Sex Place of death (City or Town) (State)
3. 4. — 5. _.. 6.
PERMISSION REQUESTED FOR:
T-] BURIAL I I CREMATION I I TEMPORARY STORAGE I I DISINTERMENT
(Complete Item 11 below) (Complete Item 12 below)
7.
Place of disposition (Cemetery or Crematory) (City or Town) (State)
Name of funeral director Business Address
7.,ur-ee Funeral • -.a, n St. Fair ._even, Vt. 05743
9. 10.
If temporary Place of (Name of vault) (City or Town) (State)
storage, fill storage
in this section:
11. 11A 11B 11C
If disinterment, Place of (Cemetery) (City or Town) (State)
complete this original
section: burial or
entomb- 12A 12B 12C
ment (Sexton's Signature) (Date)
12. 12D 12E
PERMISSION IS HEREBY GRANTED TO REMOVE AND DISPOSE OF THE BODY IDENTIFIED ABOVE:
Signature of clerk or deputy City or Town Date
13. - )1 -1 --7?"- 1
!, 4 -4,,,,4f, ----, -7;'-7 ---(--- 14. 15.
CEMETERY OR CREMATORY AUTHORITIES SHALL FILL OUT SECTIONS BELOW:
Body was: Date Name of cemetery or crematory Section Lot No.
I BURIED
17. 18. 19. 20.
I I CREMATED Location (City or Town) (State) Signature of Sexton or
other person in charge
STORED
0
16. 21. 22.