Bowen, Jane o _ i
DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH BURIAL-TRANSIT PERMIT Permit No. 3�1
"1
Permit for Removal, Disinterment and Reinterment
11110 1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Jane Ann Bowen Female January 1_9, 2011
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Fair Haven, Vermont December S, 1941 Whitehall , New York
7. Name and Address of Funeral Director or Authorized Person
James C. Aubin;Durfee Funeral Home 119 NOrth Main St. Fair Haven,Vt. 05743
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
❑Temporary ❑Removal from xxNecemation ❑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 idO,o2O,gO ff
0 PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
nature of Clerk or Deputy City/Town ate
•
ignatur ematoriu Official Container Number sate
JI, 3L( 2c11 2o1'1
1
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)