Golonka, Joseph E. VDH-PHI 2011 VERMONT DEPARTMENT OF HEALTH Permit No.10
BURIAL.IRANSIT PERMIT
Permit Ice Removal, Dleinterment and Reintfunent
1, D.namnra Name z. sex s. DabmOwm
Joseph E.Golonka Male Augu5129,2020
<. Cgffown of DeeN S. DNe o1 PJM fi. Plem of BlM
Butlinglon September 14, 19M Tmy,NY
]. Name and AEErei of Forms Director
• lamer A. Meunier,Brewer Funeral Nome, Inc.,24 Cameh St. P.O. Box 51301 c Luxeme,NY 12M
PERMSSION REQUESTED FOR:1Cnxkanyanemaamecmpleutlm arpogale zcuonl
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• PERMISSIONGIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE Older 18, V.S.A. 5201)
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Spears of Setlon/coneery Official or Represenm a of Organizalion Receiving Donation Dale
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PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE Tris 18. V.S.A. 5201)
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Name of Crermoum Comfort" Dale
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE (Tab 18, V S.A.MAN
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Signature of Cramabaum Official CcntaNer NumWr Dab
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PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE Me 18,V.S.A.5201)
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• NamBOl Cemeleryor Place to wber¢ 5aay iS bBing bMen Cay?own, $IabIX COUMry Deh
Pine View Crematory Queensbuny,NY Augu%30,2020
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE (Fab 18,V s.A 5201) pp
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