Parrish, Richard NEW YORK STATE DEPARTMENT OF HEALTH e
Vital Records Section Burial - Transit Permit
ermit
Name First Middle Last Sex
Richard W. Parrish Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 12, 2016 61 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death IL.] Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Philip J. Gara, Dr.
Address
318 Broadway Fort Edward 12828
, Death Certificate Filed District Number Regist Number
, City, Town or Village Fort Edward �`j`7 5 5
e_❑Burial Date Cemetery or Crematory
February 16, 2016
❑Entombment Address
®Cremation
Date Place Removed
I' ❑ Removal and/or Held
and/or Address
CO Hold
Date Point of
a ❑Transportation Shipment
0 by Common Destination
Carrier
Date Cemetery Address
❑ Disinterment
❑ Reinterment Date Cemetery Address
°°` Permit Issued to Registration Number
F.r/ Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
.� Address
82 Broadway, Fort Edward NY 12828
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 huma s descri edtapov a indicated.
Date Issue-I(p a)((0 Registrar of Vital Statistics V i
(signature)
District Number al Place G,�-,k_
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 02/16/2016 Place of Disposition P nc, V;eM) c,re 4a-y
(address)
(section) (lot number) (grave number)
'` Name of Sexton or Person in Charge of Premises cic�Cm.ty/0 s i I c�
(please print)
Signature Title Crei► (ito(
(over)
DOH-1555 (02/2004)