Borden, Harold DHAS-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 I
Date of Death
HAROLD MORO BORDEN
4.Citylrown of Death 5. Date of Birth 6. Place of Birth
Castleton Nov. 11 , 1921 Norristown, PA
7. Name and Address of Funeral Director or Authorized Person
Douglas V. King, Durfee Funeral Home, Fair Haven VT 95743
PERMISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from ]E]Cremation ❑Burial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
• SECTIO orarystorage. •
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 r ityfTown 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 CitylTown 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
SECTIO omplete this sectionbody will be cremated.)
Name of Crematorium City/Town, State Date
Pine View Crematorium ueensbur , New York �Apr . 21 , 19U
PER,MISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A.5201)
Sicr> re of C rk or D ut �� Cityfrown Da !
Sig t e of re torium Official Container Number Date
� ;, 7-
17
• omplete this section • or •
Name of Cemetery Citylrown 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
Citylrown, 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)