Hill, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH 0 _ I!_116 716
Vital Records Section Burial - Transit Permit
,1 N• ame First 1 Last Sex
Elizabeth Rose 11111fr Hill Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/08/2018 88 , War or Dates
Place of Death Hospital, Institution or
City, Town or Village Chestertown Street Address Deceased's Residence
Manner of Death El Natural Cause ❑ Accident El Homicide 0 Suicide riUndetermined � Pending
Circumstances Investigation
Medical Certifier Name //�� Title
Magdeline lnzerilli, VS-f C_
Address
6223 State Rte 9 Chestertown, NY 12817
Death Certificate Filed District Number Register Number
City, Town or Village 54 5a a
• 0 Burial Date Cemetery or C�remai;or
❑Entombment 03/09/2018 /�-e t'� (_f,e 4/alit'/�✓i
Address
`r®Cremation � ,ke r- �2 2 (m L) Yi r U` �''�
?_
Date Place Removed
Removal and/or Held
and/or Address
Hold
' Date Point of
'' Transportation Shipment
,.` by Common Destination
'' Carrier
, Disinterment Date Cemetery Address
w Date Cemetery Address
ti❑ Reinterment
Y Permit Issued to Registration Number
41 Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
; A• ddress
4-.: 9 Pine St/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
„ R• emains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rem 'n described above as indicated.
i Date Issued 63-00 4 Registrar of Vital Statistics Cciwkjr
( " ature)
• D• istrict Number 5425 Place 1 0(3-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3,-(3-I k Place of Disposition I inc. ✓; ,i c fte.g4of>
(address)
s-; (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 6 f.rm ey ,?..,Uir-t-,S
(please print)
Signature��o � �.. Title ��w''!car
(over)
DOH-1555 (02/2004)