Newton, Deborah NEW YORK STATE DEPARTMENT OF HEALTH s
Vital Records Section Burial - Transit2 Permit
Name First Middle Last Sex
Deborah A. Newton Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/24/2016 62 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
F Manner of Death o Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Pending
Circumstances Investigation
Medical Certifier Name ...›Title
Darci Gaiotti-Grubbs, Vn
Address
102 Paork St Glens Falls, NY 12801
5 Death Certificate Filed District Number �O Regisl .uummber
Y City, Town or Village II
0 Burial Date or Crnat6ry )
07/26/2016 Ce d z-'(. l0i� �/ Ci.�iii ce��/ e--r,
0 Entombment Address
tt ®Cremation �� � ,('6 - 7 i'�P4'
Date ace Removed
0 Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
x Carrier
0 Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
<; Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
_'r Address
r 9 Pine St/P.O. Box 455 Chestertown NY 12817
r 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.
Registrar of Vital Statistics
Date Issued 72-6 ) 1 9 l/ cJ.AQ UL),.^^-cilkAt
(signature)
District Number 5 60( Place C ,..As 'cc,« S , 14
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
x Date of Disposition /127'a, Place of Disposition 13
4.f.0v✓ Lrlrrnak�
(address)
g (section) if
(lot number) (grave number)
9 l�l� ` 41 Name of Sexton or Person in Charge of Premises irs l K
(please print)
S.Signature e Title ate In lire.
(over)
DOH-1555(02/2004)