Sparks, Gladys DH-PHS-BTP-89a VERMONT DEPARTMENT OF HEALTH
BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name(first,lgiddle ast) 2 x 3. to of Death
• 4.CibfZrown of Dgath 5. to of Birth 6. Place of Birth
7. e d A dr ss qt Funeral Dire for or orized Person
P MISSION REQUESTED FOR:(Check only one box and complete appropriate section)
❑Temporary ❑Removal from Cremation Aurial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
SECTIO orary storage. • •
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 13� (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/Town Date
Signature of Sexton/Cemetery Official Date
SECTIO omplete this sectionbody will •-
N e of Crematoriu .� City/Town, State Date
Rynr�l�tit+.y�ti. �I-GU � 5�%995
PERMISSION 'S
GIV OSE OF SAID BODY TATE ABOVE. (Title 18,V.S.A. 5201)
• Sig lure f Cler r D I ZQbL94194n DatEj
Si nat of Crem Offic' Container Number Date p
SECTION • • • 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 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)