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Brunette, Thelma NEW YORK STATE DEPARTMENT OF HEALTH 7.-C6 Vital Records Section 0 Pit Burial - Transit Permit Name First Middle Last Sex Thelma I. Brunette Female Date of Death Age 88 If Veteran of U.S.Armed Forces, I- April 3, 2006 War or Dates Z Place of Death Hospital, Institution or W City, Town, or Village Queensbury Street AddressThe Landing G Manner of Death © Natural Cause El Accident 0 Homicide EISuicide 0 Undetermined 0 Pending 0 Circumstances Investigatiork U Medical Certifier Name Title Ill William Borgos, M.D. Q Address 14 Manor Drive, Queensbury, NY 12804 i Death Certificate Filed District Number Registe;Number City, Town or Village Queensbury 5l Date Cemetery or Crematory ❑ Burial April 5, 2006 PINE VIEW CREMATORY Address Z ❑X Cremation QUAKER RD QUEENSBURY, NY 12804 Date Place Removed 0 0 Removal and/or Held r and/or Address • Hold 0 Date Point of 4 0 Transportation Shipment , by Common Destination d Carrier = Date Cemetery Address 0 ❑ Disinterment El Renterment Date Cemetery Address Permit Issued to ' Registration Number Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00135 Address F- 9 Pine St. / P.O. Box 455, Chestertown, New York 12817 n Name of Funeral Firm Making Disposition or to Whom i Remains are Shipped, If Other than Above aAddress Permission is hereby granted to dispose of the human rem ' s describ boy asindicated. Date Issued -5- Registrar of Vital Statistics �- „.? i---`q (signature) District Number S Q Place Queensbury,New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: P ,'� DispositionJ1 t)"i. k) CRE,A 1 -}'DTZ.\ yj 2 W Date of Disposition L P�C2 Place of ! w (address) d It (section) t"�) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises &, )4 N — . W lease print) Signature '' 6.t j_ 0- Title CO g 4,1 4"-/"d iZ