Aitken, Victor ORK STATE DEPARTMENT OF HEALTH pp
Records Section Burial - Transit Permit
Name First Middle Last Sex
Victor G. Aitken Male
Date of Death Age If Veteran of U.S. Armed Forces,
03/15/2012 57 War or Dates Place of Death Hospital, Institution orty -/e.; 4('i� . i_;i:
w City, Town or Village Chestert p Street Address Deceased's Residence y / 7
Manner of Death❑Natural Cause Accident 0 Homicide Q Suicide 0 Undetermined Pending
141
C.) Circumstances Investigation
�, Medical Certifier Name ��� Title
PAUL BACHMAN,
Address
3767 Main ST. Warrensburg, NY 12885
Death ificate Filed --- District Number Register Number
City,(ro v4 Village �f' f/� c�j �—
®Burial Date Cemetery or Crematory
03/19/2012 Pine View Cemetery
❑Entombment Address
OCremation Aviation Rd. ( ) C (It-,--- x/ '- /�—7 �' 2
Date Place Re ved
z Removal and/or eld
and/or Address
Hold
Date Point of
ey. ID Transportation Shipment
by Common Destination
0 Carrier
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/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
w
Permission is hereby granted to dispose of the huma re ains d sc ' ove s indicated
Date Issued 3 / f/ Registrar of Vital Statistics/ ` ..-6- --
l�C� .
/ ` (s. nature)
District Number c-5211 Place eij....42/-(3,y71-41,,e_,6c-i-tL---/U-� / 31 7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Mi Disposition 3/1 9/1 2 Place of Disposition Pine View Cemetery
iii (address)
Erie 10 A 1
} (section) (lot number) (grave number)
0 Name of Sexton or Pers i harge of Premises Michael Genier
(please print)
W Signature -`^'' Title Superintendent
(over)
DOH-1555(02/2004)