Morrisey, Dawn A. 9- 351
NEW YORKSTATE DEPARTMENT OF HEALTH BUriai - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Dawn A.Morrise Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/13/2020 62 Years War or Dates
Il- Place of Death Hospital,Institution or
WCity,Town or Village Chester Town Warren Street Address 36 Olmstedville Road,Chester Town Warren,New York 12860
p Manner of Death ®Natural Cause Accident 1:1Homicide ❑Suicide Undetermined Pending
uJ Circumstances Investigation
U
WQ Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Chestertown 5652 6
❑Burial Date Cemetery,Crematory or Facility Name
04/15/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
U-N Hold Address
O
IA Date Point of
to Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
jo Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/14/2020 Registrar of Vital Statistics 911indy Conway(ECectronically Signed)
(signature/
District Number 5652 Place Chestertown, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition ffd 'ZD Place of Disposition
Lu address/
2
W
cc N (section/ ((et number) (grave number/
O Name of Sexton or Person in Charge Wmises �)
Z
(lease p t
W Signature Title f
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) r 013550
Receipt
Human remains of delivered on , 20
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Pine View Cemetery Representing the fitheral home named on burial permit
Official Funeral Directors Reg.or License#'