Edin, Marion NEW YORK STATE DEPARTMENT OF HEALTH %--- - ' 31e6--
Vital Records Section Burial - Transit Permit
Ili Name First Middle Last Sex
Marion Edlin Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/17/2015 78 War or Dates
1 Place of Death Hospital, Institution or
City, Town or Village ChestertNa Street Address Deceased's Residence
Manner of Death El Natural Cause El Accident El Homicide El Suicide El Undetermined El Pending
Circums ances Investigation
Medical Certifier Na r—r / Title
(//
4 A dr Ge SiC�C12�� k./7 r/I// -- /
- Death ' sate iled District Number Register N mber
City, ow r Village �1 c_c ^ --7 ✓'�--p ,.r—,2 .
:Burial Date Cemetery of Crematory ,
f44 05/19/2015 f/ /4 (,/t„edvr 4 " ' ' vL,
•❑Entombment Address G� 1
®Cremation �(9��'-c /asp _/�� / )-RF /
�- .' Date ace Removed
❑ Removal
1 and/or Held
.a I and/or Address
'` Hold
Date Point of
Transportation Shipment
i by Common Destination
Carrier
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
gv Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
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 he eby ranted to dispose of the human r ma s describe o as in mated:
f Date Issued / % '- Registrar of Vital Statistics /g //Y
- (signature)
ty District Number. i052 Place ie—e.-e--/t
t. ' I certifythat the remains of the decedent identified above were disposed of in accordance with this permit on:
p
Date of Disposition `i(UK Place of Disposition s♦rin,,a./ (wht'w
(address)
(section) r t_, (lot number) (grave number)
Name of Sexton or Person in Charge of Premises `I^ Sty
(please print)
Signature el
Title d'iz mt'tik.
(over)
DOH-1555(02J2004)