Freligh, Patricia NEW YORK STATE DEPARTMENT OF HEALTH - 3,3
Vital Records Section 1/4 ' Burial - Transit Permit
t
Name First Middle Last Sex
Patricia M. Freligh Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/28/2012 87 War or Dates
li- Place of Death Hospital, Institution o ,,-
uj City, Town or Village Cheste Street Address 6j� /� /� /f vw
d'� r�<t/l�O�j fl' d �f�c�� i.i .
fili Manner of Death Q Natural Cause ❑ Accident ❑ Homicide❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
WW Medical Certifier Name Title
WILLIAM C. ORLUK,
Address
6223 State Rte 9 Chestertown, NY 12817
Deat ificate Filed District Number Register Number
CityVrowo,brVillage Cj, ./1--r j(o�� -
❑Burial Date C Crema�to
❑Entombment 07/30/2012 $/?-( i/ zP� ��� C ! v c�J
Address El Cremation t mi 1, (' �7.r4 ' GJ
Removal Date lace Removed
z and/or and/or Held El
H Hold Address
(7 Date Point of
a ❑Transportation Shipment
V! by Common Destination
El Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
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
I— Remains are Shipped, If Other than Above
2 Address
W •
Q' Permission is hereby granteddispose to of the human a s descri.,, ,: :•,ve indicated.
Date Issued 1p0�/ARegistrar of Vital Statistics �,�e,
(signature)
District Number s6,5o Place \21,(1.-->2. V (4/2_iii. F.../teJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
alDate of Disposition-)-30-lZ Place of Disposition 4",'1(1e Ji et..) C-l'c►ti►a4o11/4.'utin
W (address)
Cl)
CC (section) ;;�� (lot number) (grave number)
a Name of Sexton or Person in Charge of Premises I a-L !l`v v{lie
W �� (please print)
Signature 6� .....§. Title __Seel w.'rcI7 ASV/
(over)
DOH-1555 (02/2004)