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Moon, Sawyer
r ! ,W 7 7J- NEW YORK STATE DEPARTMENT OF HEALTH // ' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Sawyer Martin Moon Male Date of Death I nurAge I If Veteran of U.S. Armed Forces, na/2at2n1a Ilnknn War or hates Place of Death Hospital, Institution or City, Town or Village Albany Street Address Albany Medical Center Hospital Manner of Death©Natural Cause Ei Accident 0 Homicide Suicide ElUndetermined 0 Pending Circumstances Investigation Medical Certifier Name Title Haritha Sishtia Mn �, ot Address ' 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2120 ❑Burial Date Cemetery or Crematory 09/28/2018 Pine View Crematorium UEntombment Address to Ai®Cremation Queenbury, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier EN V LiDisinterment Date Cemetery Address ; 0 Renterment 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 41 Name of Funeral Firm Making Disposition or to Whom a° Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. ;4 '�'' irate issued ua/LwzUlti Registrar of Vital Statistics (Battelle y'tuespie(EtectrontcatLySigned) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Data f Disposition Place f n:___s: • f /' vain of vlaNualtiuill ��r( �I� Place in Disposition I , ,+d It �� (address . 4. (section) (I%,;number) (grave number) Name of Sexton or Person in Charge of Premises 11 l„ thv't (Ileasd Pn"nt) ri Signature 6 1.417 Tide (i?Ardi'l. (over) DOH-1555 (02/2004)