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O'Kane, John james NEW YORKSTATE DEPARTMENT OF HEALTH "" Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John James O'Kane Male Date of Death Age If Veteran of U.S.Armed Forces, 05/08/2020 89 Years War or Dates 1953-1955 Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 13 Burial Date Cemetery,Crematory or Facility Name 05/11/2020 Pine View Crematorium Entombment Address 4V X Cremation Queensbury Hamlet,New York y 3 3f: , Donation 0 Removal Date Place Removed and/or and/or Held H N Hold Address _1 O (L Date Point of U) ❑Transportation Shipment p by Common Carrier Destination EjDisinterment 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 IX W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/11/2020 Registrar of Vital Statistics Kpt(:Ceen C.Gorak(ECearonicaffy 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: / W Date of Disposition ��It`� ZO Place of Disposition d-)0-1/ � 6�� (address) W (section) (lot number) (grave number) cc 8 Name of Sexton or Perso � Charge of Premises vlti 1/�h (please print) W Signature Title DOH-1555(o7/18)p 10 Public Health Law Sec. 4145(2b) , e 013778 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#