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Barton, Ramona L. �-T NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ramona L Barton Female Date of Death Age If Veteran of U.S.Armed Forces, 01/21/2020 89Years War or Dates Place of Death Hospital;Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death © Natural Cause ❑Accident Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title Madison Zuis NP Address 112 Ski Bowl Rd,Johnsburg Town, New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 Burial Date Cemetery,Crematory or Facility Name 01/21/2020 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held F-N Hold Address O d Date Point of 0 ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped,If Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2020 Registrar of Vital Statistics Kathleen C. Lorah(Electronically Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 1/ZZ Zia Place of Disposition 2 (address) W N (section) (lot number (grave number) CName of Sexton or Person in Charge of Pr mises ` �� i) (please Print)Z W Signature Z Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .3 2 6 6" Receipt Human remains of delivered on , 20— Pine View Cemetery Representing the funeral`home named on burial permit Official Funeral Directors Reg.or License#