Bardwell, James DH-PHS-35-72 STATE OF VERMONT Permit No.
BURIAL-TRANSIT PERMIT
Permit for Disinterment, Transportation and Reinterment
Fu -•.e of deceased L2.
Date of de
1. _/ 2. /r://y7 Coloreface Age Sex Place of death (City or Town) (State)
3. 4.v Z 5. 6. eZr- , 41./ .
PERMISSION RE U STED FOR:
URIAL I I CREMATION I I TEMPORARY STORAGE I I DISINTERMENT
7 (Complete Item 11 below) (Complete Item 12 below)
Place of disposition
(Cemetery or Crematory) (City or Town) (State)
8* f2X-Ie .
/e...e•-**4•10
rilli)
Name of funeral director 4nsAddress .°6644411"167
9� 10. 4.64.44001:007-16, dectee.
If temp Place of p ry (Name of vault) (City or Town) (State)
storage, fill storage
in this section:
11. 11A 11B 11C
fl 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 REMOVE AND DISPOSE OF THE BODY IDENTIFIED ABOVE:
%nature of clerk or deputy City or To Dat /
/
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der/
dy was
ETERY v OR CREMATORY Dateem cemetery AUTHORITIES SHAName of a SECTIONS
orr crematory Section ,& . k'oli I, Lot No. * "'`4:-'
BURIED 17.-�//912 18. ��`'V 19. 20.
I I CREMATED Location City or Town) (State) Signature of Sexton or
_f C� � other person in charge
STORED j (sue
�Q/ f!•
16. 21. •
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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.
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.
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 Sec. 5215 Vermont Statutes Annotated.
PENALTY for violation is not more than $500 or less than $20.
SEC. 5212-VSA. Permit to remove dead bodies. A person desirous of disinterring or removing the body of a human
being from one cemetery to another cemetery or to another part of the same cemetery or from a tomb or receiving vault
elsewhere, shall first obtain a written permit from the town clerk of the town where such dead body is interred or entombed.
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