Hunter, John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
�, John Pershing Hunter Male
r. Date of Death Age If Veteran of U.S. Armed Forces,
-_ 12/02/2018 74 Years War or Dates
° Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Addree:; Glens Falls Hospital
Manner of Death Ed Natural Cause 0 Accident ❑Homicide 0Suicide Undetermined Pending
` Circumstances Investigation
41
Medical Certifier Name Title
Jean Vanauken PA
'ti%4�nV Address
IX' 100 Park St,Glens Falls,New York 12801
; Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 568
}❑BUrial Date Cemetery or Crematory
12/04/2018 Pine View Crematorium
"%❑Entombment
,, Address
'r
®Cremation Queensbury, New York
V Date Place Removed
Removal and/or Held
and/or Address
4 Hold
Ik Date Point of
Transportation Shipment
by Common Destination
.bl Carrier
,
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
1
o Permit Issued to Registration Number
0 Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Paz Address
'0 9 Pine St,Chestertown,New York 12817
•
Name of Funeral Firm Making Disposition or to Whom
,f, ' Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/03/2018 Registrar of Vital Statistics g?p6ertA Curtis(E(ectronica((ySigned)
u (signature)
elt
District Number 5601 Place Glens Fans, New York
r`
'* I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
��� Date of Disposition ja.-11-4 Place of Disposition fit vpyt/ t;,rx,rw,to('Y
(address)
(section) (lot number) (grave number)
a
Name of Sexton or Person in Charge of Premises J uY"`v X ?ci fe,S
� , (please print)
Signature gi, Title C/rtrn4i`btr
(over)
DOH-1555 (02/2004)