Cahill, Estelle NEW YORK STATE DEPARTMENT OF HEALTH ?%
Vital Records Section . , It Burial - Transit Permit
Name First Middle Last Sex
Estelle A. Cahill Female
P., Date of Death Age If Veteran of U.S. Armed Forces,
4 04/13/2015 93 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Street Address FORT HUDSON NURSING HOME
Manner of Death 0 Natural Cause Accident Homicide Suicide ❑ Undetermined Pending
Circumstances Investigation
Medical Certifier -� Title
MIT'.1 sn7.79 .1_
r ress
377 e,c6,M_, c/d ?c7 1c - ,��Y/)- A r
Death Certificatled District Nu be Regis a umber
`� - City, Town or Villaqe 755 t 6
❑Burial Date or Crematory /;
04/13/2015 b ( /--e /ov/. .,-Y!
❑Entombment Address
A�El Cremation -, c/i ..� � / "
S ' Date Place Removed
Removal and/or Held
and/or Hold Address
. Date Point of
sp.
.5i' ElTransportation Shipment
-: by Common Destination
Carrier
: ,, Li Disinterment
Date Cemetery Address
r
U, Reinterment
Date Cemetery Address
Permit Issued to Registration Number
p4.*
AV Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
r r0
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
,.w. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
s Address
5,
isrog Permission is h eb granted to dispose of the human r ins described bove indicated.
,,go Date Issued 4`/�3 /� Registrar of Vital Statisti
17%kV ..---- - (signal e)
' .` District Number Place/Ay7 C., .-- i &ItAA'2_,/
41
0 ,, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 4 11'4(/c Place of Disposition 1) �,.: ,,._
(address)
} (section) x (lot number) (grave number)
Name of Sexton or Person in Charge of Premises + °ir
please print)
Signature Title (17>=0, 4
(over)
DOH-1555 (02/2004)
3