Olsen, Sally A Jul 23 2021 07:25PM Aldous/Durfee/Bamard F H 802773939; : page 3 6)`
VDH-PHS-BTP_2011 VERMONT DEPARTMENT OF HEALTH Permit No.
BURIAL-TRANSIT PERMIT
Permit for Removal,Disinterment and Reinterment
1.Decedent's Name 2.Sex 3.Date of Death
Sally A Olsen
4.City/Town of Death7,emale (July 20,2021
5.Date of Birth 6.Place of Birth
Castleton January 7,193 2 �Brooklyn,NY
7.Name and Address of Funeral Director
Christopher J.Book,Aldous Funeral Home,44 North Main Street Rutland,VT 05 701
PERMISSION REQUESTED FOR:(Chock only one box and complete the appropriate section)
❑ Temporary Storage or Donation(Section A) 0 Cremation(Section C) ❑Burol or Entombment(Section D)
Removal from Temporary Storege/Plece of Donation or Disinterment(Sachet B) ®Removal from State(Section E
SEC 1lct, A IF c )
`E,J�r �Fz�;F� .;���a,�c� c�1>�'::r1;�-,,:,rd IN VLrVoNr
Name of Cemetery/Place or Donation Facility City/rown Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATTD ABOVE(Title 18,V.S.A.5201)
Signature of Clerk/Deputy or Funeral Director : JCltTow,,
I Date
•
Signature of Sextortreemetery Official or Representative of Orgnization Receiving Donahoe Date
SEC I K,',E. IF PLIVOWAI, F ROI,1 I FVPnr t,,,-'r :,Tl">Rn(,F I'I ACE OF GoNA' AN(7I?LISINT EI;r,^Lf:i
Name of Cemetery/Place or FadNfiy from which body is being ' •ved City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATIC)ABOVE(Title 18,V.SA.5201)
Signature of Clerk/Deputy or Funeral Director 1City/Town
Date
Signature of Sexton/Cemetery Official Date
Name of Crematorium Clty/ own Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STA ABOVE(Title 18,V.SA.5201)
Signature of Clerk/Deputy or Funeral Director City/Town
Date
Signature of Crematorium Official I Container Number Date
IC ;'li)N D IF Fi JRIAL 7,.F., EN rOMB'J'kNT I',1 'ERf:1(')NT
Name of Cemetery City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATE ABOVE(Title 18,V.S.A.5201)
Signature of Clerk/Depuly or Funeral Director , 1City/Town 'Date
Body was: Buried Entombed I Data
Section Lot Number Grave Number ± Signature of Sexton/Cemetery Official
CT1riN F 1F RENICU,4 rROr,,i S'"AfL
Name of Cemetery or Place to where body is being taken City own,State or Country Date
Pine View Crematory Queenshury,NY July 23,2021
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.SA.5201)
11l�TNl6tyorF renal ri ICity4� IDa,te—
v.,tic a 3-ab21
is permit is filed with the Clly/rown Clerk by the 10th day of the month following diapos Rion.(Title 18 V.S.A.5215)
Public Health Law Sec. 4145(2b) 01 4 9 7
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#