Field Sr, Ronald E c
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
Ronald Edwiii Field, Sr. Male May 19,1997
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland, Vermoiit December 14, 1927 Cavendish, Vermont
7. Name and Address of Funeral Director or Authorized Person
Jim Aubin Roberts—Aubin nnleral Home, 17 Allen Avenue, Potzltne , Vremotit 05764
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
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 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 own Date
Signature of Sexton/Cemetery Official Date
SECTION C: (Complete this section if body will be cremated.)
Name of Crematorium City/Town, State Date
Pine View Crematoritim nsbury, New York May 20,1997
PE MIS N IS GIr
TO ISPOSE OF SAID BODY ASS T D ABOVE. (Title 18,V.S.A. 5201)
Sign tur o Clerk o u y City/To Date
igna f C num Official Container Number Date
a4��L 4t 671
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 own Date
Body/Cremains were ❑ Buried ❑ Entombed Date
Name of Cemetery Section —7Lot 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)