Ward, Louise 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
Louise N. Ward Female November 4, 1997
4.CitylTown of Death 5. Date of Birth 6. Place of Birth
Bennington June 16, 1944 Saratoga Springs,NY
7. Name and Address of Funeral Director or Authorized Person
Flynn Brother ' s Inc. , 80 Main Street, Greenwich, NY 12834
PERMISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from [RCremation ❑Burial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
SECTIONcomplete
Place of Storage(Name of Cemetery or Vault) CitylTown, 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 oval fromtemporarystorage or disinterment. complete •
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 wn, State 7/07/97
ate
Pine View Crematory Queensbury, New York
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
Si ature of CI D uty City/Town Date
Deputy Registrar Bennington 11/04/97
re of re atori Off' ' Container Number to
r L/
SECTION D: (Complete this section if body/cremains will be buried or entombed.)
Name of Cemetery CitylTown 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 Lot Number Grave Number
CitylTown, State Signature of Sexton/Cemetery Official
This permit is to be filed with the CitylTown Clerk by the 10th day of the month following disposition. (Title 18,V.S.A.5215)