Norton, Ruth way GU 16 v I vT}J riuvuV . i.
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VDH-PHS-BTP-2011 VERMONT DEPARTMENT OF HEALTH Permit No. 27 L
BURIAL-TRANSIT PERMIT
Permit for Retrtoval.Disinterment end Reir!terment
1_Dams Name +�� 2.Sex 3. Date of Death
Ruth T, Norton Foredo May 23, 2012
4,City/Town of Death 15.Date of B rth 6. Pace of E ,rt't
Rutland City !Juno 22, 1920 j Albany, NY
7 Name and Address of Funerai Director
iJiiison Funeral Home,46 Williams Street,Whitehall NY 128$7
jPERMISSION REQUESTED FOR, (Check only one box and Somplete the appropriate section)
0 Temporary Storage or Donation(Section A) ❑Cremation(Section C) 13 Burin or entombment(Section 0)
® ReToval Groin Temporary Storage/Piste of Donation or Disil> nient(Section S: Fa Removal From State(Section E)
SE., IION A. IF I EMPORARY S,'ORAG E.OR UONA1ION IN' t_RMONT
Name of Cemetery/Face or Donation Facility CitytTewn Data
iT PERMISSION 3IVEN TO DISPOSE OF SAID BODY AS STATED ABOVE;Me 18,V.S.A.5201)
Signature of ClerI!Deputy or Furx a'Director City/Town f Date
Signature of Sexton Cemetery Official or Representative of Organization ReceIvirg Donator, !Date
t;LG tJOH U: It IIEMOvAI_ I i'IOIVI I Er/lI'0ftArtY SI CIIIAGLif....ACL.iit ..XUF4AIION OR DISINTERMENT
Name of CemetleryPPlace or FeciJity tom which bocy is being removed City/Town Date
PERMISSION vIVEP TO DISPOSE OF SAID BODY AS STATED ABOVE ITitie 18..V.S.A.5201) ...r
Signature of Clerk/Deputy or Funeral Director City/Town Date
Sig-nature of Sexton/Demeter,Official 1 Da;e
SECTION C.IF CREMATION.IN VERMONT
Name of Crematorium City;i own Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE Mile 18_, V.S.A 5201)
Sig nature of Clerk/Deputy or Funeral Director City//Town Date
Signature of Crematorium Officia Container Ncrrtber Date
SECTION OAF BURIAL OR EN IOMBNIENT IN VERMONT
Noma of Cemetery City/Town iDate
J PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18 V.S.A, 520r,, _
Signature of CIerKFOeouty or Funeral Director City/Town t?ale
Body was: Q Buried 0 Ertombed Date
Seaton Lot Number Grave Number Signature c=3extontCemetery Offio:a''
SECTION E:IF RCMOVAL FRAM STATC
Name of Cemetery or Place to where body is being taken City/Town,State or Country Data
Pine View Ceniatoritur. QQueensbury,NY Mcy 29,,2012
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Tir4e 18 V S.A 52E1)
5i ne of Clerk/De2 t Funer D.neCtor Cif: v Dat
is tc : J with the cityrrcovr,Clark Cy the Qth day f: e nlonti blowing d!epcaiticn.r,7Itie 13 .S.A 5215)
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