Donovan, Kaitlyn Morgan VDH-PHS-BTP-2011 VERMONT DEPARTMENT OF HEALTH Permit No. `dA
BUFtW,-AAANSIT PERMIT
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name 2. Sex 3. Date of Death
Kaitlyn Morgan Donovan Female December 07, 2019
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Burlington September 22, 1988 Watertown, NY
7. Name and Address of Funeral Director
Stephen K. Gregory, Baker Funeral Home, 11 Lafayette Street Queensbury,NY 12804
PERMISSION REQUESTED FOR:(Check only one box and complete the appropriate section)
Temporary Storage or Donation(Section A) Cremation(Section C) ❑ Burial or Entombment(Section D)
Removal from Temporary Storage/Place of Donation or Disinterment(Section B) ® Removal from State(Section E)
SECTION A: IF TEMPORARY STORAGE OR DONATION IN VERMONT
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
•N 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 - OR ENTOMBMENT IN VERMONT
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 Date
Body was: Buried Entombed Date
Section Lot Number rave Number Signature of Sexton/Cemetery Official
SECTION • FROM STATE
Name of Cemetery or Place to where body is being taken City/rown, State or Country Date
Baker Funeral Home Queensbury,NY December 09, 2019
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18, V.S.A. 5201)
Signaturo of Clerk/Deputy or Funeral Director City/Town F
ate //I
This permit W to be filed with the City/Town Clerk by the 10th day of the month following disposition.(Title 18 V.S.A.5215)
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#