Serro, Christine NEW YORK STATE DEPARTMENT OF HEALTH, w. 4 is-1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Christine Rose Serro Female
Date of Death Age If Veteran of U.S. Armed Forces,
r 03/04/2015 63 War or Dates
Place of Death Zj,.•j��wi Hospital, Institution or
City, Town or Villagesek Street Address Adirondack Tri County Health Care Center
Manner of Deathm
LILI Natural Cause 0 Accident 0 Homicide Ej Suicide ri Undetermined Pending
Circumstances Investigation
Medical Certifier Name—
AZ
dress S
Ad
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l7
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Deat► K=' -te Filed-- District Npm er �, Register Number
City, Tow •r Village \I(2I, Alf � � 1. ep
ElBu .-
Date ,Cemetery or Crematory
03/06/2015 /// Z-4-,i J (72-e1-7-f /c)/ '9'-:.--7
❑Entombment Address
®Cremation w-- -z: i _�d7 Z 2 9"
Date ce Removed
:„ Removal and/or Held
a and/or Address
Hold
" ., Date Point of
IN
❑Transportation Shipment
, k
by Common Destination
Carrier
:t4
Disinterment Date Cemetery Address
1.
Reinterment Date Cemetery Address
zoo?
,1 i: Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
r Address
9 Pine St/ P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereb granted to dispose of the human re ains descnbedpbove a icated.
Date Issued Registrar of Vital Statistics �� Q ,,
(signature)
?= District Number Sj_D Place i u c. (1
I certify that the remains of the decedent identified above were disposed of in accorda with this permit on:
Iiiu Date of Disposition 3)SI is''' Place of Disposition i li.ca C ar,
(address)
(section) Al- ot number) (grave number)
Name of Sexton or Person in Charge of Premises '2k iniit
(please pant)
; ,s Signature '�-� Title Cribtfrita2.
(over)
DOH-1555(02/2004)