Parrott, Constance 7T LI1
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Constance I Parrott Female
Date of Death Age If Veto-are S_Aimed Forces,
F. March 17, 2016 rj 3 War or Dates
Z Place of Death Han.ph n Hospital,Institution or I to 25 e'.u-e%fli iWotc.+-e- I I
iii City,Town,or Village idalteltall Street Address Residence
0 Manner of Death ®Natural Cause 0 Accident 0 Homicide El Suicide El Undetermined El Pending
W Circumstances Investigation
0 Medical Certifier Name Title
U Dr. Bradley Berryhill, M.D. Dr.
0 Address
Castleton Family Health Center, Route 30N, Bomoseen, VT 05732
Death Certificate Filed I-i a m ko n District Number Register Number
City,Town or Village Wh 5'7 J 6 S
❑Burial Date Cemetery or Crematory
March 21, 2016 Pineview Crematorium
❑Entombment Address
0 Cremation Quaker Road Queensbury, NY 12804
L Date Place Removed
0 0 Removal and/or Held
- " Hold
Address
Pi .
1 Date Point of
4 El Transportation Shipment
A by Common Destination
Carrier .
Date Cemetery Address
tiDisinterment
❑Reintnt Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jilison Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
Name of Funeral Firm Making Disposition or to Whom
XRemains are Shipped,If Other than Above
W Address
Permission is hereby granted to dispose of the hum ins described bove as indicated.
Date Issued 311 g/�140 Registrar of Vital Statistics M 5. •/Lowl
(sit)4 ; )
District Number 5768 P 1-16.rnp4-an, (JQu.. Vork
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
fit Date of Disposition 03/21/2016 Place of Disposition Pineview Crematorium
2 (address)
B
W
(section) number) (grave number)
O Name of Sexton or Person in Charge of Premises r; Sit
P )
Signature t:L 444 Title M I
(over)
DOH-1555 (02/2004)