Griffin, Bruce R 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) 2. Sex 3. Date of Death
Bruce Robert Griffin Male May 319 1991
T 4. City/Town of Death 5. Date of Birth 6. Place of Birth
Fair Haven I March 31 , 1935 Rutland , Vermont
7. Name and Address of Funeral Director or Authorized Person
Doiigias V. Kgng, Durfee Funeral Hnme. Fir Haven Vermont 05743
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
❑Temporary ❑Removal from ®Cremation ❑Burial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
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 CitylTown 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
IJ,,ne 1 1
PERMISSION IS GIVEN TO DI POSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
i n ture Clerk epty City/Town Date
Fair Haven June 1 ,1991
n tur of re tor' m O ici Container Number Date
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery City/Town 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
Body/Cremains were ❑Buried ❑ Entombed Date
Name of Cemetery Section Lot Number Grave Number
CityfTown, State Signature of Sexton/Cemetery Official
This permit is to be filed with the CityfTown Clerk by the 10th day of the month following disposition. (Title 18, V.S.A.5215)