Hayes, Lyla NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lyla Hayes Fema1?
Date of Death Age If Veteran of U.S. Armed Forces,
05/25/2014 70 yrs. War or Dates N/A
Place of Death Hospital, Institution or Fulton Center for Rehabilitation
Z N2ay, Town kid Johnstown Street Address and Healthcare
p Manner of Death IX I Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Jeffrey Aminon M.D.
Address
847 County Highway 122, Gloversville, New York 12078
Death Certificate Filed District Number Register Nuer,
Town Y+� Johnstown /2-C7'
/
D Burial Date Cemetery or Crematory
05/29/2014 Pine View Crematorium
❑Entombment Address
Cremation Queensbury, New York
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine Street, Queensbury, New York 12817
Name of Funeral Firm Making Disposition or to Whom
t_- Remains are Shipped, If Other than Above
2 Address
re
O.
Permission is h
hereby granted to dispose of the human remain gscribed alMi indicated.
Date lssued.7 A5/2,4*/Registrar of Vital Statistics ��
/ (signature)
District Number / 7511 Place
I certify that the remains of the decedent identifie a ov were disposed of in accordance with this permit on:
gDate of Disposition (./ (pi Place of Disposition ,klifm/ &r-etik
W (address)
U)
(section) (lot num r) r (grave number)
p• Name of Sexton or Per on in Charge of Premises ,L- (2 L, .Scrod
Z (please print) U
W Signature . L Title Catt''iKa
(over)
DOH-1555(02/2004)