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Edwards, Peter DH-PHS-5B-78 STATE OF VERMONT 4111111 BURIAL-TRANSIT PERMIT Permit No DECEASED—NAME FIRST MIDDLE LAST SEX DATE OF DEATH(Month,Day,Year) 1 Peter C• Edwards 2 id 3 RACE—(White,Black, AGE LAST BIRTH- UNDER 1 YEAR UNDER 1 DAY DATE,�ok�O,pF�ByIR1tT�aHd COUNTY OF DEATH AmericanIndian, DAY(Years) MOS. DAYS HOURS MIN. (3o ,iO"'A927 7A Rut1 and! 4 ETC.(Specify) white SA B© 58 5C 6 J V 3�i land! CITY,TOWN OF DEATH y �HjOOSPIITTAfL OR�OTHER�INSTITUTION of notinnfeither, y, IF HOSPITAL or INSTITUTE 78 Rutland 7eiCardilia"RegiO"uei Medical Center ❑ Inpat. ❑ ER 1 E PERMISSION REQUESTED FOR: ❑ BURIAL tfiO CREMATION ❑ TEMPORARY STORAGE (Complete Item 12 below) 8. PLACE OF DISPOSITION(Cemetery rematory)& ia4tg (CITY OR TOWN) (STATE) 9. 1 itj /�� SADDRESSNAME OF FUNERAL DIRECTOR 0 1 0. kJ 1 v /� /� p/� //y�` 11. //�/�//�� `,,/) /�- /i. fr. IF TEMPORARY PLACE OF (Name of vault) (CITY OR TOWN) (STATE) STORAGE,FILL STORAGE IN THIS SECTION: 12. 12A. 12B. 12C. PERMISSION IS HEREBY GRANTED TO REMO AND DISPOSE OF HE BODY IDENTIFIED ABOVE: 0 Signature of clerk or deputy CITY OR T N DATE / Sititd 13. ,,�I 14. 15. 7 r/ CEMETERY OR CREMATORY AUTHORITIES SHAL ILL OUT SECTIONS BELOW: BODY WAS: DATE 7 nG NAME OF CEMETERY OR CREMATORY jJ_ SECTION LOT NO. ❑ BURIED 17.7/G" /4 18. 1 / 71 e C r e Al�' ! 0 r t t/✓Irk, 19. 20. ��yyyrrr LOCATION (CITY OR TOWN) (STATE) SIGNATURE OF SEXTON OR yK CREMATED OTHER PERSON IN CHARGEr /❑_STORED /4 J t~°'e n 5 v� 7 t• y 9 /'1 1 C1Stc SSS / 22. 9eav, 16. 21.