Hammond, George NEW YORK STATE DEPARTMENT OF HEALTH 5U
Vital Records Section Burial - Transit Permit
, iii
Name First Middle Last Sex
George J. Hammond Male
Date of Death Age If Veteran of U.S. Armed Forces,
F December 21, 2006 82 War or Dates World War II
Z Place of Death Hospital, Institution or
W City, Town, or Village JOHNSBURG Street AddressAdirondack Tri County Health Care Center
O Manner of Death x❑ Natural Cause ❑ Accident Homicide El Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
W Medical Certifier ���/� l� Title
c1 ,
a Ad ress
Death Certificate Filed District Number Register Number
City, Town or Village North Creek �S'�O .3 9
Date Cemetery or Crematory
❑ Burial December 22, 2006 PINE VIEW CREMATORY
Address
Z ❑X Cremation OUARER RD OUEENSBURY, NY 12804
Date Place Removed
4 ❑ Removal and/or Held
r and/or Address
Hold
0 Date Point of
4 ❑Transportation Shipment
a by Common Destination
hi Carrier
= Date Cemetery Address
a ❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00135
Address
1_ 9 Pine St. / P.O. Box 455, Chestertown, New York 12817
Name of Funeral Firm Making Disposition or to Whom
ix Remains are Shipped, If Other than Above
I Address
Permission is hereby granted to dispose of the human remains described ab as indicated.
Date Issued /a oZ / :form() Registrar of Vital Statistics ti. 51k ei ficsa�l
(signature)
District Number c 6 5 j Place TOWN OF JOHNSBURG NORTH CREEK, NY 12853
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition I I/Az/4, Place of Disposition gqiv u.., (r ,i f'or iv".
W2 (address)
0
(section) of number) (grave number)
Name of Sexton or Person inn Charge of Premises Cb r, $ e'sine if
/4 i'd�-' - (please print)
Signature „tA-- Title n :.tcdr