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Smead, Betty t # 7s1e NEW YORK STATE DEPARTMENT OF ALTH Vital Records Section ft Burial - Transit Permit Name First Middle Last Sex 0 Betty L.Smead J' Female Date of Death Age If Veteran of U.S. Armed Forces, 09/18/2018 87 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Johnsburg Town Street Address Elderwood at North Creek Manner of Death Undetermined Pending©Natural Cause ❑Accident El Homicide ❑Suicide ❑ ❑ Circumstances Investigation Medical Certifier Name Title James Hindson 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 24 ❑Burial Date Cemetery or Crematory 09/19/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York • Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of "❑Transportation Shipment by Common Destination Carrier r ❑Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/18/2018 Registrar of Vital Statistics 7 h(een C.Lorah(E(ectronica((y 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: Date of Disposition lilt iii Place of Disposition Q,oV.� it Date (address) (section) lot number) (grave number) Name of Sexton or Person in Charge of Premises r 464,6e- 3 0"I161 , (ple print) 4,44 Signature r' Title CROATo2- (over) DOH-1555 (02/2004)