Murtagh, Catherine NEW YORK STATE DEPARTMENT OF HEALTH ' s 237
Vital Records Section Burial - Transit Permit
Name First Middle Last I Sex
Catherine B. Murtagh I Female
;-L.v Date of Death I Age T If Veteran of U.S. Armed Forces,
o ti 03/22/2017 7I 95 War or Dates
Place of Death Hospital, Institution or
m Oil City, Town or Village Glens Falls Street Address Glens Falls Hospital
lirManner of Death X❑ Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑Undetermined ❑ Pending
Circumstances Investigation
r Medical Certifier Name Title
William Cleaver, Aq
s ~ Address
100 Park St. Glens Falls, NY 12801
- h Certificate Filed / District Nu r Register Number
Cit Town or Village �(�c K ii� (o/ /7 7
I Burial 1 Date or, emato/�
03/23/2017 I i i- /i,u . (,I�!'Ll c, Ainr/v✓!`
�:❑Entombment Wi Address /�
®Cremation (�C v-e.. /,Id-h t� �y
Date Place Removed
❑ Removal and/or Held
, v and/or Address
Hold
Date Point of
, -,❑Transportation Shipment
a by Common Destination
Carrier
6 Date Cemetery Address
❑ Disinterment
ff
"❑ Reinterment Date Cemetery Address
ti Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
41.
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
hi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
,; Permission is hereby granted to dispose of the human remains described above as
s-indicated.
Date Issued 3/23 j i 7
Registrar of Vital Statistics lwG,„),ye_ ' '-� eortvi�
(signature)
District Number(5-40/ Place 11 Sr. QI y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition yz 3 i 7 Place of Disposition /���CU, !�l�m���/ (address)
(section) (lot number) (grave number)
,;,. ;
Name of Sexton o rson 'n Charge of Premises �J LA, 1��...•1 74✓4 C-
(please print)
Signature Title ��
(over)
DOH-1555(02/2004)