Barton, William NEW YORK STATE DEPARTMENT OF HEALTH -1
Vital Records Section Burial - Transit Perm t
Name First Middle Last Sex
William L. Barton Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/24/2006 84 years War or Dates
j-. Place of Death Hospital, Institution or
iTi City, T9 XX ( Saratoga Springs Street Address 21 Loughberry Rd,
W Manner of DeathLA,Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
Circumstances Investigation
;t Medical Certifier Name Title
fl James Noonan Md
Address
1 West Ave, Suite 330, Saratoga Springs, Ny 12866
Death Certificate Filed District Number Register Number
City, Togo-Xlnn Saratoga Springs 4501 214
❑Burial Date Cemetery or Crematory
['Entombment Pineview Crematorium
Address
12Cremation Queensbury N Y
Date Place Removed
F=`
❑Removal and/or Held
and/or Address
Hold
U)
0 Date Point of
Q Transportation Shipment
d by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00453
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
;a Address
lr
Ili
CL
Permission is hereby granted to dispose of the human remains escr'bedv s Indic ted.
<i Date Issued 05/25/2006 Registrar of Vital Statistics
(signature)
» District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iti Date of Disposition ',; %;, t, Place of Disposition Pin z:v u (r-.r,.-;'T 0 r 3
(address)
iii
ta
IC (section) (lot number) (grave number)
ci Name of Sexton or Person in Charge of Premises ( (c 1 Lt,.,nP% '
2 / (please print)
Signature , ,,v, -, f l Title ( '' i�^ �`'�
(over)
DOH-1555 (02/2004)