Hayes, Lester c., ,7—/
NEW YORK STATE DEPARTMENT OF HEALTT-I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
460
V Lester Wayne Hayes Male
* Date of Death Age If Veteran of U.S. Armed Forces,
03/21/2017 73 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Ckid-c/_` Street Address 7 ct 7- 4)if e
, .
Manner of Death 0 Natural Cause EI Accident El Homicide ❑ Suicide Undetermined Pending
Circumstances Investigation
N Medical Certifier Name � � Title
PAUL BACHMAN,
; Address
3767 Main ST. Warrensburg, NY 12885
Death 1 to Filed / � �,L District Nu ber Register Nu ber
City own illage �J1l�<< /�' 6 u�,,�_ •.
Burial Date C or,Cr�Crematory p f--
'�` 03/22/2017 I if'1 e (//-e e.<,/ (, /C / -'i -1
❑Entombment Address
®Cremation fCr ,(-/ 4///‘ . ('/Y/)-rM 1
Date Place Removed
Removal and/or Held
and/or Address
;;L . Hold.
Date Point of
'`, Transportation Shipment
by Common Destination
"r Carrier
Date Cemetery Address
g4 Li Disinterment (.
Reinterment Date Cemetery Address
.rn LiPermit Issued to Registration Number
11, Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
Y 9 Pine St/P.O. Box 455 Chestertown NY 12817
liA Name of Funeral Firm Making Disposition or to Whom
. Remains are Shipped, If Other than Above
' Address
*111
is�grantedto.dispose of lbetwman remains. above as"indicated.
s Date Issued Registrar of Vital Statistics g/f") :AcLi'‘ (signature)
O District Number 51(.p'`1 Place T,744
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
; :� Date of Disposition Z 3 /7 Place of Disposition �l7-)a u r e G.-ie-mc.�t✓�7
(address)
s (section) (lot number) (grave number)
Name of Sexton or,Per ,in have of Premises
v /('n'l CJ��l'
(please print)
Sig nature /�� Title C �--;41a/k 7
.
(over)
DOH-f555(0212004)