Honaker, Shirley sr 13
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH 33
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
• 1. Decedent's Name (first, middle, last) 2. Sex 3. Date of Death
Shirley Ann Honaker Female .Tanuary 19, '?011
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland. Vermont May 13, 1941) Grundy, Virginia
7. Name and Address of Funeral Director or Authorized Person
James C. Aubin;Durfee Funeral Home 119 North Main St. , Fair Haven,Vermont 05743
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
❑Temporary ❑Removal from i3Ximation ❑Burial or
0 Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment
(Section B) (Section D)
SECTION A. (If temporary storage. complete this section.)
Place of Storage(Name of Cemetery or Vault) City/Town, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Signature of Clerk or Deputy City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION B: (If removal from temporary storage or disinterment complete this section.)
Name of Cemetery or Vault from which body is being removed City/Town Date
Name of Cemetery where body is being taken City/Town, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
Signature of Clerk or Deputy City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION C: (Complete this section if body will be cremated.)
Name of Crematorium City/Town, State Date
Pine View Crematory Queensbury, New York 'ddrIT' a70,.90//
41) PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
Si nature of Clerk or Deputy City/Tq n ate
G2crLc /C''rl !�7` pm,:9d1 �1/l
ignature r matorium Offi ' I Container Number ate
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery City/Town Date
0 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Signature of Clerk or Deputy City/Town Date
Body/Cremains were ❑Buried ❑ Entombed Date
Name of Cemetery Section Lot Number Grave Number
City/Town, State Signature of Sexton/Cemetery Official
This permit is to be filed with the City/Town Clerk by the 10th day of the month following disposition. (Title 18, V.S.A. 5215)