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Wilson, Harriet Beatrice A 61. NEW YORK STATE DEPARTMENT OF HEALTH `a Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harriet Beatrice Wilson Female Date of Death Age If Veteran of U.S.Armed Forces, 01/15/2020 90 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Gloversville Street Address Mountain Valley Hospice Manner of Death ©Natural Cause Accident Homicide Suicide El Undetermined ❑Pending lu Circumstances Investigation WMedical Certifier Name Title Christopher Hoy MD Address 161 Carey Road,Queensbury Town,New York 12804 Death Certificate Fled District Number Register Number City,Town or Village Gloversville 1 1701 15 Burial Date Cemetery,Crematory or Facility Name 01/17/2020 Pine View Crematorium ❑Entombment Address aCremation Queensbury Hamlet,New York Donation Removal Date Place Removed F and/or and/or Held N Hold Address tL Date Point of 0 ❑Transportation Shipment p by Common Carrier Destination ❑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,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W 9" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2020 Registrar of Vital Statistics 9enniferXazur(ElectronicaffySigned) (signature) District Number 1701 Place Gloversville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ?p Place of Disposition j->. j 9 Uj Uj ( dress) IIIV lsectiwrJ (lot number) (grave number) Name of Sexton or Person in Charge of Premis , please print) W Signature Title f DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013256 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I