Morris, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH ` ' I(
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Elizabeth R. Morris Female
Date of Death Age IfVeteran of U.S. Armed Forces,
02/23/2017 90 War or Dates
Place of Death C Hospital, Institution or) 7fj',� &7
City, Town or Village t- ri- Street Address Deceased's Residence
Manner of Death Natural Cause ❑ Accident ❑Homicide El Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name n Title
{ ,, Shannon Evellis, �"
Address
6223 State Rte 9 Chestertown, NY 12817
Death Certificate Filed District Number Register Number
Y
City, Town or Village
0 Burial Date Csrrretery or Crematory 4.�'
❑ 02/24/2017 /12� -P /l /z?-I ,4'�l vl�
Entombment Address l
®Cremation ��s�j e i-t/7d//<---.
Date 0 Place Removed
❑ Removal and/or Held
of and/or Address
Hold
Date Point of
'` ❑Transportation Shipment
by Common Destination
Carrier
ElDisinterment Date Cemetery Address
- ID Reinterment Date Cemetery Address
1 ., Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
ri Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
IName° of Funeral Firm Making Disposition or to Whom
7;-: Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re i Med above as indicated.
Date Issued a-a`{ U 17 Registrar of Vital Statistics
ignature)
District Number 5(05:a Place 'T A. 0i C,(ACS4-e
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
a. Date of Disposition ZIA/r) Place of Disposition (Co(1--- elmg{pn�
(address)
(section) / (lot number) (grave number)
Name of Sexton or Person in Charge of Premises rw _LA it
E, I(please print)
Signature Title � mf}�ti
(over)
DOH-1555(02/2004)