Blue, Isabelle 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
Isabelle Blue Female Feb. 24, 1997
4. City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland I Oct. 27 1902 Staten Island N.Y.
7. Name and Address of Funeral Director or Authorized Person
Dou las V. Kina, Durfe
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 ': (If temporary storage, • •
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 wn 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 7
77 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
SECTION C� (Complete this section if body will be cremated.)
Name of Crematorium City/Town, State Date
Pine V' w Crematorium /I Oueensbury, New York F2/27/97
PERMISS IS GIVEN TO DISPOSE OF ID BO Y AS STATED ABOVE. (Title 18, V.S.A. 5201)
Sign to Clerk or ty City o n. t Date
L
Si drXture of Cr t?/r um Official Container Number 6ate
j^ pzlu / v `
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 CitylTown 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 City/Town Clerk by the 10th day of the month following disposition. (Title 18, V.S.A. 5215)