Stannard, Hazel ']
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name(first, middle, last)0
2. Sex 3. Date of Death
Hazel Phelps Stannard Female Jan 6, 2011
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Fair Haven,Vermont Aug 31, 1918 Fair Haven,Vermont
7. Name and Address of Funeral Director or Authorized Person
Durfee Funeral Home&Cremation Service P.O.Box 86,119 North Main Street Fair Haven,VT
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
0 Temporary 0 Removal from 6 Cremation 0 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,VS. 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,VS. 5201)
Signature of Clerk or Deputy City/Town Date
Signature of Sexton/Cemetery Official
SECTION C: (Complete this section if body will be cremated)
Name of Crematorium City/Town, State Date
Pine View Crematory Queensbury NY0 Jan 10, 2011
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,VS. 5201)
nature of Clerk or Deputy City/Town Date
,'YGZ� 0_G carat,. . � c GG Fair Haven,Vermont Jan 7, 2011
ignatur Crematoria fficial C Date
�-, JAA i1011
SECTION D: (Complete this section if body or creaminess will be buried or entombed)
Name of Cemetery City/Town Date
illPERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,VS. 5201)
Signature of Clerk or Deputy City/Town Date
Body/Cremains were ❑Buried 0 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 City/Town Clerk by the 10th day of the month following disposition. (Title 18,VS. 5215)