Hayes, Chelsea Rose •
NEW YORK STATE DEPARTMENT OF HEALTH 2 31,
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Chelsea Rose Hayes Female
Date of Death Age If Veteran of U.S.Armed Forces,
0110/2022 26 Years War or Dates
ZPlace of Death Hospital,Institution or
Z City,Town or Village Poughkeepsie Street Address 31 Glenwood Avenue, Poughkeepsie, New York 12601
LU
p Manner of Death El Natural Cause ❑Accident Homicide OSuicide Undetermined Pending
UCircumstances Investigation
Q Medical Certifier Name Title
Dennis Chute MD
Address
168 Washington St,Poughkeepsie,New York 12601
Death Certificate Filed City Of Poughkeepsie District Number Register Number
City,Town or Village 1302 279
Burial Date Cemetery,Crematory or Facility Name
'_' 03/15/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Z❑Removal Date Place Removed
and/or and/or Held
H Hold Address
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0
C- Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 •
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
}.. Remains are Shipped,If Other than Above
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/14/2022 Registrar of Vital Statistics Catk.nne4Scnzolette(Electroni SsInei9
(signature)
District Number 1302 Place City Of Poughkeepsie
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
31, . L
Z Date of Disposition S {Z Z Place of Disposition .-
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u1
(address)
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CC (section) (lot numbe 51.1
r) (grave number)
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p Name of Sexton or Person in Charge of Pr ises
Z (plea print)
W Signature Title Cmq�Q
DOH 1h55(o//18)p t of 2
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1 Public Health Law Sec. 4145(2b)
1
1 Receipt
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Human remains of , ' • , - delivered on , 20
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1 Pine View Cemetery Representing the funeral home named on burial permit
1 Official Funeral Directors Reg.or License# ' • '• 1