Murphy, Mildred NEW YORK STATE DEPARTMENT OF HEALTH 3 to
Vital Records Section Burial - Transit Permit
tl Name First Middle Last 1 Sex
s
Mildred Mary Murphy I Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/01/2018 85 War or Dates
Place of Death Hospital, Institution or 3 7 e/%d 7 /17`e
City,Town or Village Chestertown Street Address sad's-Resirice
. Manner of Death Natural Cause 0 Accident El Homicide.Q Suicide Li Undetermined Li Pending
Circumstances Investigation
Medical Certifier Name � Title
i 3
JOHN K. RUGGE,
:4 Address
6223 State rte 9 Chestertown NY 12817
W Dee icate Filed �r�� _ District Number I Register Number
�, Cit , own r Village ( (f,<� 1 •
s;
`
Date / r
�; ❑Burial
�u 05/02/2018 ��- � Le'�i C9�/ 7 ` 0�i�
zft ❑Entombment Address //��''�� (� /
®Cremation CSC 4 4� --��-/.cf/J,�t ✓I' -7/�a'I-/
Date I Place Removed 7
Removal and/or ( and/or Held
Hold Address
{,01 Date Point of
Al 0 Transportation Shipment
by Common Destination
%6' Carrier
❑ Disinterment Date Cemetery Address
Reintermenttr
Date Cemetery Address
Permit Issued to I Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. I 00141
1 �4 Address
9 Pine St/ P.O. Box 455 Chestertown NY 12817
A Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
4 4, Permission is hereby granted to dispose of the human remain d scribed above as indicated.
' Date Issued 5-51 �c9 oil. Registrar of Vital Statistics QM.
ature)
',,,'-ig, District Number Sti Place 1 ac -)vV (?'s t5 v-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 5/2 i(Q Place of Disposition f ti(1.,. CA,..,
(address)
S (section) (lot number) (grave number)
w Name of Sexton or Person in Charge of remises ak S 411'
/1�
lease print)
Signature �1 Title r> /Na
(over)
DOH-1555(02/2004)