Morehouse, Travis L. .'�� LI6111
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Travis L.Morehouse Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/15/2022 35 Years War or Dates
ZZ Place of Death Hospital,Institution or
ILI
City,Town or Village Chester Town Warren Street Address 1401 Friends Lake Road,Chester Town Warren,New York 12817
p Manner of Death 0 Natural Cause ❑Accident Homicide Suicide Undetermined ❑Pending
UJ
0 Circumstances Investigation
G Medical Certifier Name Title
Lynn Keil PA
Address
1340 State Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Chester District Number Register Number
City,Town or Village 5652 8
Burial Date Cemetery,Crematory or Facility Name
® 06/18/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
F= and/or and/or Held
N Hold Address
0
O. Date Point of
U)nTransportation
p by Common Shipment
Carrier Destination
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,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped,If Other than Above
a Address
LC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/17/2022 Registrar of Vital Statistics 31indy Conway(E(ectronica[lySigned)
(signature)
District Number 5652 Place Town Of Chester
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i—
Z Date of Disposition ��p in. Place of Disposition -F V_,_ ^-�
(p
W
2 (address)
W
Cr U) (section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises 1 a b i
Z (pt se print)) �y,��
iW Signature gTitle 1" A�f���
Z7,--
DOH-1555(o7/18)p 1 of 2
j Public Health Law Sec. 4145(2b) fff F
1
1
1 Receipt
I
1 ' ,,
Human remains of r'' '` `_ ; ' 'd livered on - f < 20
i 1
1
Pint View Cemetery Representing'the funeral home named on burial permit
Official Funeral Directors Reg.or License#% _