Cady, Henry DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
0 1. Decedent's Name(first, middle, last) 2. Sex 3. Date of Death
Henry Edward Cady Male April 27, 2011
4. City/Town of Death 5. Date of Birth 6. Place of Birth
City of Rutland Nov. 23, 1931 Day, New York
7. Name and Address of Funeral Director or Authorized Person
Todd J. Valenti 11 Lafayetee Street Oueensbury New York 12804
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
E Temporary ❑Removal from - ®Cremation ❑Burial or
410 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 Crematorium Town of Queensbury 4/29/2011
4111) PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Si a of Clerk or1Pe•utyy City/Town Date
—i-- , p�yz- City of Rutland 4/28/2011
Lure Crematori Official Container Number Date
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)