Farmer, Howard NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ,: Burial - Transit Permit
oek Name First Middle Last } Sex
Y.
y Howard H. Farmer ' Male
., Date of Death Age If Veteran of U.S. Armed Forces,
Y War or Dates
1 0/11/2016 65
Place of Death Hospital, Institution or
11City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Deathm
LIIJ Natural Cause El Accident EI Homicide 0 Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name / ff Title
, �l Gj
' Add ss � � ��
` . . �A �7 g ��� <�
-• Certificate File District Num Reg ster Number
own or Village
Burial Date or Crem,ato e
10/12/2016 ,Ze-frt
- . C/' (/ "4/ i
It ///1
❑Entombment Address
®Cremation 1 e( '''€e-4r . C. 7 / ��
Date ace Removed /
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
',El Renterment
Date Cemetery Address
� �
*1 Permit Issued to Registration Number
6?, Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
A 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
4 Address
TT
m Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued i(D112, J ! 6, Registrar of Vital Statistics W cl ti�-v�2
(sigma re)
District Number 56 0 ) Place G CQ'Y'S \X S j kJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I /L3116 Place of Disposition ZrtiOt •J c+matOritr,r
(address)
�*
(section) i-(lot number) (grave number)
Name of Sexton or Person in Charge of Pre ises a(c 3 taNi-
( ease print)
• Title Cite 116-1 A--
Signature !yt
(over)
DOH-1555(02/2004)