Parkhill, Margaret • STATE OF VERMONT Permit No. ~-11 ��.t/...
DH-PHS-33-72
BURIAL-TRANSIT PERMIT
Permit for Disinterment, Transportation and Reinterment
Full name of deceased 714:--1!..,1:
r',^ ,� /1 ee Date of death
1. )714 /{:C/), ILA 2. /ice G
Color or Race 7 e Sex Place of death (City or Town) / (State)
9 °
3. �1 l' . 6 5. V 6. f)7 (?� !-l t
PERMISSION RE UESTED FOR:
RIAL I I CREMATION I I TEMPORARY STORAGE I 1 DISINTERMENT
(Complete Item 11 below) (Complete Item 12 below)
7.
Place of disposition (Cemetery or Crematory) (City or Town) (State)
r
) -ir ID
8. "e✓ �C.r-�-C/ Ir Z
Na of funerp,l d' actor Business dress
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10. 4, �i/
/-.-
If tempor rry / Place of (Name of vault) (City or Town) (State)
storage.fj4 .-/ storage
in this ection:
1111
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 HEREBYGRANTED TO REMOVE AND DISPOSE OF THE BODY IDENTIFIED ABOVE:
S' na re of I rk or deputy City o To n Date
1,
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15. l,1- ��../l L (
1 • Ql)
CE ET RY OR CREMATORY AUTHORITIES SHALL FILL OUT SECTIONS BELOW:
B y wOs: ,;' Date Name of cemetery or crematory , _Section Lot No.
URIED 17./ /✓/,, 78. U.1 "L` �ti�A t €.G.� 19. 20.
I I CREMATED Locat'on {City or Town►-"' (State) Signature of Sexton or
other person in charge
I I STORED -''
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ill
16. zt. 22.