Hoyt, Linda NEW YORK STATE DEPARTMENT OF HEALTH 1, # 3/,
Vital Records Section Burial Transit Permit
A
P ` Name First dle Last Sex
Linda J. `'' •
• Hoyt Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/12/2016 72 War or Dates
. f Place of Death Hospital, Institution or 7�p .f7 ,Z
City, Town or Village Brant Lake Street Address Deceased's Residence
Manner of Death L/LiNatural Cause El Accident 1=1Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
William C. Orluk, GCr(' ,
Address
,, 268 Darrowsville Rd., Chestertown, NY 12817
Death Certificate Filed � District-Number RegisterJjumber
City, Town or Village �Qr/C7 3(0 54 5
❑Burial Date or Crematory
❑Entombment 05/13/2016 �`e �`e �� ,6i.c, <,�
�'� Address es 7 _S �`
;`®Cremation �� /� X�pX
Date Place Removed /
Removal and/or Held
and/or Address
Hold
,(4), Date Point of
w El Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Ta
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
f' 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
1 Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human r ai described a ve indica
Date Issued 5-/3-/ i Registrar of Vital Statisti
(signature)
f District Number �? 1 Place o..f ' ---/-�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition sal. M. Place of Disposition i w
a�ddress)
tk
(section) t number) (grave number)
r Name of Sexton or Person in Charge of P mises 6 ^�'� L �k^'�'
(plea print)
Signature Title CU r`1` 1
(over)
DOH-1555(02/2004)