Hughes, Gareth 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
Gareth Vernon Hucrhes male June 5 1995
4.City/Town of Death 5. Date of Birth 6. Place of Birth
Rutland I Feb. 5, 1922 Fair Haven, Vermont
7. Name and Address of Funeral Director or Authorized Person
Doucilas V. Kincf, Durfee Funeral Home 119 No. Main St. , Fair Haven VT 05743
PERMISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from j1 Cremation ❑Burial or
Storage Temp.Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
• SECTION A (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/fown Date
Signature of Sexton/Cemetery Official Date
SECTIO om temporary storage • • •
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/Town Date
Signature of Sexton/Cemetery Official Date
SECTION • • body will • cremated )
-
Name of Crematorium City/fown, State Date
Pine View Crematorium Oueensbury, New York 6 5 95
134ftyl,6611UN IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18,V.S.A. 5201)
• Si na ure of lerk or epu City/Town Date
r Rutland 6/5/95
a re C atoriu ffic' Container Number Date
a aQ 6 SECTION �s-
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/Town Date
Body/Cremains were ❑Buried ❑Entombed Date
Name of Cemetery Section Lot 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)