Maranville, Norma VDH-PHS-BTP-2011 VERMONT DEPARTMENT OF HEALTH Permit No.
BURIAL-TRANSIT PERMIT
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name 2.Sex 3. Date of Death
Norma E. Maranville Female July 30,2017
4.City/Town of Death 5. Date of Birth 6. Place of Birth
O Rutland City March 15, 1933 Glens Falls,NY
7. Name and Address of Funeral Director
Carleton Funeral Home, 68 Main Street, Hudson Falls,NY 12839
PERMISSION REQUESTED FOR: (Check only one box and complete the appropriate section)
❑Temporary Storage or Donation(Section A) 0 Cremation(Section C) 0 Burial or Entombment(Section D)
O Removal From Temporary Storage/Place of Donation or Disinterment(Section B) Q Removal From State(Section E)
SECTION A: IF TEMPORARY STORAGE OR DONATION IN VERMONT
O Name of Cemetery/Place or Donation Facility City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A.5201)
Signature of Clerk/Deputy or Funeral Director City/Town Date
Signature of Sexton/Cemetery Official or Representative of Organization Receiving Donation Date
SECTION B: IF REMOVAL FROM TEMPORARY STORAGE/PLACE OF DONATION OR DISINTERMENT
Name of Cemetery/Place or Facility from which body is being removed City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Signature of Clerk/Deputy or Funeral Director City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION C: IF CREMATION IN VERMONT
Name of Crematorium City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Signature of Clerk/Deputy or Funeral Director City/Town Date
Signature of Crematorium Official Container Number Date
SECTION D: IF BURIAL OR ENTOMBMENT IN VERMONT
0 Name of Cemetery City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Signature of Clerk/Deputy or Funeral Director City/Town 1Date
Body was: 0 Buried ❑ Entombed Date
Section Lot Number Grave Number Signature of Sexton/Cemetery Official
O SECTION E: IF REMOVAL FROM STATE
Name of Cemetery or Place to where b dy is being taken City/Town,State or Country Date
Pine View Cemetery / Queensbury,NY August 04,2017
PERMISSION GIVEN • 4ISP OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Si atur oiii,erk/a zr. for F ral Director C y n � Date/
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This permit o be led ivG th the City/Town Clerk by the 10th day of the month following disposition.(Title 18 V.S.A.5215)