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Raymond, Madeline NEW YORK STATE DEPARTMENT OF HEALTH N -Zir Vital Records Section Burial - Transit Permit Name First Middle Last Sex 1A , Madeline May Raymond Female ',, Date of Death Age If Veteran of U.S. Armed Forces, 04/15/2016 82 War or Dates Place • �_-ath M Hospital, Institution or/07'/(�� an.-P r City, ' o n or Village G m€tedviBle !'1141-e f V� Street Address Deceased's Residence c//,f bx vi/ Manne : Death a Natural Cause EI Accident ED Homicide D Suicide El Undetermined Ei Pending : Circumstances Investigation Medical Certifier Name Title Jennifer Donovan, DO, ,.„, Address 126 Ski Bowl Rd North Creek, NY 12853 Deat ificate Filed District Number Register Number �y1 Cit Tow or Village /I"lI I'l if Vt( i ❑Burial Date GertjtETy�of Crem4$ry i, 04/18/2016 ©iiil 1/('C,i,(J 1,t I/44Ct /0 r!r/1,14 5. Entombment Address ®Cremation Q(/u1�.�-, � ati,,,1-0-/ .... 1/I/ 1)-ro ,, r' Date Place Removed " ``' Removal �'�°�; and/or Held and/or Address Hold Date Point of 4'.El Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address `❑ Reinterment Date Cemetery Address k Permit Issued to Registration Number w , Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141 ,,e, Address " `,:€ 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 ereby granted to dispose of the human r ins described above as indicated. Date Issued 4 I 2 o I Registrar of Vital Statistics - c_-:„Thx_c,_ (—Ink a -" ' -- (signature) LiV N �7District Number 1 5 Place h�,Ar,ex-kick. NY 12€3`a 7 1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 11 l/s A Place of Disposition FM,(La Ci-vmatorii— ,r (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of P emises ` r' Mal- (lot lease print) Signature !mot Title aWM1111-- .;...,.. (over) DOH-1555(02/2004)