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VDH-PHS-BTP-2011 VERMONT DEPARTMENT OF HEALTH Permit No. 23y,
BURIAL-TRANSIT PERMIT
Permit for Removal,Disinterment and Renterment
1,Dece t s Name �"�`� -2. Sex -3.Date of Death
Emma J.Turco Female March 24, 2016
A.City/Town of Death 5.Date of Birth 'S.Place of Birth
Burlington December 08, 1939 Rutland City,VT
7.Name and Address of Funeral Director
.. Jilison Funeral Home,Inc.,46 Williams Street, Whitehall,NY 12887
PERMISSION REQUESTED FOR: (Check only one box and complete the appropriate section)
❑Temporary Storage or Donation(Section A) 0 Cremation(Section C) ❑Burial or Entombment(Section D)
❑ Removal From Temporary Storege/Place of Donation or Disinterment(Section 8) El Removal From State(Section E)
SECTION A IF TEMPORARY ,TOF:AGE CP 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
SEC PION R 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 1Cityflown 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 U: IF BURIAL 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: 0 Buried 0 Entombed Date
Section Lot Number Grave Number Signature of Sexton/Cemetery Official
SECTION E IF REMOVAL FROM STATE
Name of Cemetery or Place to where body is being taken City/Town,State or Country Date
Pine View Crematorium Queensbury,'NY March 24,2016
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Signature of Clerk/Deputy Funeral Director City/Town�'} O�Oe
permit
This is toibh a with the City/Town Clerk by the Loth day of the montbr following disposition.(Title 18 V.S.A.5215)