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McDonald, Ronald C.
NEW YORK STATE DEPARTMENT OF HEALTH # 79 Bureau of Vital Records Burial - Transit Per It Name First Middle Carol A Casabonne Last Sex Date of Death Age If Veteran of U.S.Armed Forces, Female 11/29/2019 83 Years War or Dates �. Place of Death WCity,Town or Villa a Hospital.Institution or Queensbu Town Manner of Death Street Address 192 Fuller Road, Queensbury Town, New York 12804 WQ ©Natural Cause Accident Homicide Suicide Undetermined El Pending WW Medical Certifier Name Circumstances Investi ation Robert Love Title Address MD 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City,Town or Village Queensbury District Number Register Number Burial Date 176 Cemetery,Crematory or Facility Name Entombment Address Pine View Crematorium Address _ aCremation Queensbury Hamlet,New York Donation ❑Removal Date Place Removed and/or and/or Held Hold Address Transportation Date Point of .# by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Name of Funeral Home Barton-Mcdermon Funeral Home Inc Registration Number Address 00141 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address tt 4 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2019 Registrar of Vital Statistics CaroCrneNiddegarde Barber(ElectronicaQySWned) /signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 Date of Disposition l7 3 j I Q Place of Disposition 1e 4^..'W. ul /address) � lsecnhnl - /!ot nu rl Name of Sexton or Person in Charge of P ises A /grave number/ z GJ Lf IW Signature lPleaseprintl Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 13 1-1 q Receipt Human remains of delivered on Pine View Cemetery representing the fu eral home named on burial permit Official Funeral Directors Reg.or License# ,l