Spears, William 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
• William C. Spears Male IDec. 7 1992
4.City/Town of Death 5. Date of Birth 6. Place of Birth
Bennington Nov. 2 , 1921 Medford, Massachusetts
7. Name and Address of Funeral Director or Authorized Person
Burke & Sons , 628 North Broadway, Saratoga Springs, New York
PERMISSION REQUESTED FOR:(Check only one box and complete ippropriate 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 City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION 13� (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 7-Date
SECTION • • body will be cremated.)
Name of Crematorium City/rown, State Date
Pine View Crematorium I Queensbur , Sew Y®rk �2/10/92
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A.5201)
• Si toe of Cler City/Town Date
�=" A Bennington 12/7/92
Si t of Cre rium Official Container Number Date
-
• omplete this sectionbody 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
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)