Santacroce, Judith VDH-HSI-BTP-2023 VERMONT DEPARTMENT OF HEALT Permit No. 132.
BURIAL-TRANSIT PERMIT
Permit for Removal, Disinterment and Reint
1. Decedent's Name . Sex 3. Date of Death
Judith Santacroce Female February 02, 2024
4.City/Town of Death 5. Date of Birth 6. Place of Birth
Colchester November 12, 1945 Bald Mountain,NY
7. Name and Address of Funeral Director
David A. Muha,Regan Denny Stafford Funeral Home, 53 Quaker Road Queensbury,NY 12804
PERMISSION REQUESTED FOR: (Check only one box and complete the appropriate section)
ID Temporary Storage or Donation(Section A) Cremation or NOR(Section C) Burial or Entombment(Section D)
Removal from Temporary Storage/Place of Donation or Disinterment(Section B) ® Removal from State(Section E)
SECTION A: IF TEMPORARY STORAGE OR DONATION IN VERMONT
Name of Cemetery/Place or Donation Facility City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A.5201)
Signature of Clerk/Deputy or Funeral Director (City/Town Date
Signature of Sexton/Cemetery Official or Representative of Organization Receiving Donation Date
SECTION B: IF REMOVAL FROM TEMPORARY STORAGE/PLACE OF DONATION OR DISINTERMENT
Name of Cemetery/Place or Facility from which body is being removed City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Signature of Clerk/Deputy or Funeral Director 'City/Town Date
Signature of Sexton/Cemetery Official Date
SECTION C: IF CREMATION OR NATURAL ORGANIC REDUCTION (NOR) IN VERMONT
Name of Disposition Facility City/Town Date
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PERMISSION GIVEN TO DISPOSE OF SAID BODY STATED ABOVE(Title 18,V.S.A.52011%
Signature Clerk/De/De or F neral Director City/Town ` Date^ G�
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Signature ofB'fs..siti n acilityOfficial Containe Number Date
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SECTION D: IF BURIAL OR ENTOMBMENT IN VERMONT
Name of Cemetery City/Town Date
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A.5201)
Signature of Clerk/Deputy or Funeral Director City/Town 'Date
Body was: Buried Entombed Date
Section Lot Number Grave Number Signature of Sexton/Cemetery Official
SECTION E: IF REMOVAL FROM STATE
Name of Cemetery or Place to where body is being taken City/Town, State or Country Date
Regan Denny Stafford Funeral Home Queensbury,NY February 04, 2024
PERMISSION GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE(Title 18,V.S.A. 5201)
Sign, r: of Cle 4DlL /a(23
or Fune I Director City� �w Date
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Thispermit is to be filed with the City/Town Clerk bythe 10th dayof the month followingdisposition.(Title 1 .S. . 215)
Y
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#