Parrish, Kerri Jo NEW YORKSTATE DEPARTMENT OF HEALTH BUriat - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kerri Jo Parrish Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/18/2020 47 Years War or Dates
II.- Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 67 Lamplighter Acres, Moreau Town, New York 12803
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined � Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Susan Hayes-Masa Coroner
Address
40 McMaster Street, Ballston Spa, New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 16
Burial Date Cemetery,Crematory or Facility Name
03/25/2020 Pine View Crematory
Entombment Address
iCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
n. Date Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
0C
1111
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/25/2020 Registrar of Vital Statistics LeeannWccaAe(ElectronicallySyned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Place of Disposition c nl e e,�✓ cr- M1
Uj (address
W
N (section) (lotnumber/ (grave number/
X
0 Name of Sexton or Person in Ch a of Pre s (please print)
Z /
W Signature / Title 6
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) f 113 4 E
Receipt
jA.
i
Human remains of`: 'r k>' delivered on ' , 20 : '--
Pme mew Cemetery Representk the funeral home named on burial permit
Official Funeral Directors Reg.or License#-�`
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