Baker, Esta 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section • k,, Burial - Transit Permit
Name First Middle Last Sex
Esta Fern Barker Female
4 Date of Death Age I If Veteran of U.S. Armed Forces,
"<= 03/20/2015 86 War or Dates
< ' of Death Hospital, Institution or
Ci own or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL
anner of Death 0 Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
PAUL BACHMAN, tVib
Address
3767 Main ST. Warrensburg, NY 12885
Certificate Filed (4 / /f District Numb _r_4 Re iste ber
' City Town or Village (( )( / rq f ` , �p g �
1§`� III :urial Date ' - S_= r Cremato
03/23/2015 f/ �/r g7DrI v�
.�� ❑Entombment Address
,,'®Cremation iSeVek4 RV f• ,� / )- e zi
Date Place Removed
4„,,,,
� ❑ Removal
'? and/or Held
i and/or Address
Hold
Date Point of
❑Transportation Shipment
,' by Common Destination
A Carrier
' Date Cemetery Address
❑ Disinterment
❑ Reinterment Date Cemetery Address
r ;i Permit Issued to Registration Number
r� Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
44 Address
, 9 Pine St/P.O. Box 455 Chestertown NY 12817
m Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
'"4 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3/ 2-7?//_ Registrar of Vital Statistics LA-)C. A._f .Q LA_
(signa re)
District Number O) T Place 6 (Q,iAS , A) y
Si
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t,, Date of Disposition ? --i 1- Place of Disposition ,i'L�'`(� � �:!4' i 'iit
` ,' (address)
(section) (lot er) (grave number)
:" Name of Sexton or X in Charge of Premises �"� d
a (please print) lb11
Signature _ AVIGTitle ��- �#9 ,L.-
-- (over)
DOH-1555(02/2004)