Barton, Hilda f s
0 bS-7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Hilda Joyce Barton Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/13/2018 90 Years War or Dates
1— Place of Death Hospital, Institution or
City, Town or Village GII4lens Falls Street Address Glens Falls Hospital
a Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
IlkCircumstances Investigation
Medical Certifier Name Title
a William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 385
❑Burial Date Cemetery or Crematory
08/15/2018 Pineview Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
Hold
0 Date Point of
CL
0❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home - 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
Address
W
a" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/14/2018 Registrar of Vital Statistics Robert)!Curtis(ElectronicaffySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
til Date of Disposition S O N Place of Disposition 1,kVN"op, 1 C o w
w (address)
ca
rc (section) (lot numb rave number)
aName of Sexton or Person in Charge of Prejnises �r.iiogku 11,*
2' / (please print)
Signature 4 Air Title ( ''h
(over)
DOH-1555 (02/2004)