Sousa, Catherine i
OH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH 1
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal.Disinterment and Reinterrnent
1.Decedent's Name(first, t 2eex [!Tqeatty
4. 'y!T t 5.Date of Birth 6.Place of Birth Z2-
[7. or Auttiodzed n
PERtMlSSk*REQUESTED FOR:( ony one box and complete��appr to section)
I+J O Temporary O Removal from tiremation ❑Burial or
Storage Temp.Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
Section B
IPlaced Storage(Name Of Cemetery or Vault) j City/Towm State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. rile 18.V.SA 5201
Signature of Clerk or Deputy City/Town Date
Signature of Sextonr3emetery Official Date
}
SECTIONcomplete
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. die 18,V.SA.5201
Signature of Clerk or Deputy City/Town TDate
Signature of Sex "Cemetery Official Oate
• City/Town,Statenote
IS IVEN TOO S OF SA10 T E.aft 18."A 5201
Signatur d OrP469 CVfTown
40 XV
CoritaidvarlNumber
r CTIONiCo _ be buriecl or en!ornbed )
Name of Cemetery Ci yfTown Date
PERMISSION JS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE.(Tide 18,V.S.A.5201
:._
Signature d Clerk or Deputy r6RFovn Date
BodyrAenwku wom O 8uried O Entombed Date
Name ofCerrretery Section Lot Number Grave Number
Cityy/rown.State Signature of SextorXemetery Official
T'hie pemrit Js to be fsd with#re City/rom Clerk by the 10th day of to monM bkmfng disposftm{ride 48,V.SA l&215)
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