Maresca, Josephine NEW YORK STATE DEPARTMENT OF HEALTH
4qt
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Josephine Frances Maresca Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/12/2013 94 War or Dates
�.. Place of Death Hospital, Institution or
WCity,Town or Village Brant Lake Street Address Deceased's Residence
in
i Manner of Deathrn j Natural Cause 0 Accident El Homicide El Suicide ElUndetermined El Pending
U Circumstances Investigation
W Medical Certifier Name Title
Shannon Evens,
Address
6223 State Rte 9 Chestertown, NY 12817
Death Certificate Filed District Number Register Number
City own r Village C.,rt )4 .`5Z 5L-f oz
E 0 Burial Date Cemetery or Crematory
0 Entombment 02/14/2013
Address
®Cremation
Date Place Removed
0 � Removal and/or and/or Held
Address
E Hold
O Date Point of
L 1. 0 Transportation Shipment
O by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
H Remains are Shipped, If Other than Above
2 Address
Ct
111
CL Permission is hereby granted to dispose of the human remains d ribed above as in 'cated.
Date Issued a-/3-/3 Registrar of Vital Statistics
(signature)
District Number (,S Lf Placedor-,.
GoN"~—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tw Date of Disposition 1--I5-t3 Place of Disposition RJ11.44fou,-
2 (address)
w
ro
X (section) 7 (tot numb (grave number)
QName of Sexton or Person in Charg of Premises C "� ri
z lease print)
W Signature Title Celt-TIr3N
(over)
DOH-1555(02/2004)