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Winney, Shirley NEW YORK STATE DEPARTMENT OF HEALTH G I Vital Records Section Burial - Transit Permit Name First Middle Last Sex ,�_ Shirley /44,4 Winney Female Date of Death Age If Veteran of U.S. Armed Forces, . 09/10/2016 74 War or Dates P -ce of Death Hospital, Institution or dr Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Deatha Natural Cause Accident Homicide Suicide Undetermined Pending r' Circumstances Investigation Medical Certifier Name Title ` ' JAMES NORTH, ,7L2 Address • ,-', 100 BROAD ST. Glens Falls, NY 12801 r% ,h Certificate Filed District Number Register Nu r t City,Towp or Village (l,64,(-- t?7� o .o/ 0 Burial Date C sisierq or Crem tory //� 09/15/2016 �i/7.Q ,p�2 ( -2- -,//;•vG y-7 !'❑Entombment 2 j '®Cremation Address `�L�/ / Q * . / Date Place Removed � Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address 44 1-',.�0 Reinterment Date Cemetery Address Permit Issued to Registration Number • =, Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141 P Address Y 9 Pine St/P.O. Box 455 Chestertown NY 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address _ Permission is hereb granted to dispose of the human remains descn'b�d b e ind' e Date Issued 09 /3 2J/�Registrar of Vital Statistics //�� GZ (signature) '' 4 /� /�District Number �6©/ Place �lt ,1-*t, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition I lit Pt, Place of Disposition i,.1.01/4, `s'f M ivy (address) u (section) 4146. `(lot number) (grave number) Name of Sexton or Person in Charge of Premises i`f1 6.^ sci14i t (ease print) W / lIk �K- Signature Title AlYt (over) DOH-1555(02/2004)