Caddell, Aubry 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 73D.at7f Death
Aubry Grace Caddell Female h 15 , 1994
. 4. CityfTown of Death 5. Date of Birth 6. Place of Birth
Middletown S rings ,Vt . October 9, 1991 Rutland , Vermont
7. Name and Address of Funeral Director or Authorized Person
' Jim Aubin Roberts—Aubin Funeral Home, P.O. Box 181 ,Poultney,Vt .
PERMISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from Mremation ❑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) CityfTown, 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 CityfTown 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 Crematory lQueensbury, New York 3 /6--v
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A.5201)
S' nature of Clerk or Depty CityfTown Date
• Middletown Springs, Vt . -/�11; •/11t;q
i re of CAnatorium Offici Container Number Date
d13 1-1e:�&
SECTION • i• be buried or • •-
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 CityfTown 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 City/Town Clerk by the 10th day of the month following disposition.(Title 18,V.S.A.5215)