Gill, Janet NEW YORK STATE DEPARTMENT OF HEALTFI-
Vital Records Section Burial - Transit Permit
if, , Name First Middle Last Sex
Janet L. Gill Female
x DDate of Death Age If Veteran of U.S. Armed Forces,
12/29/2018 94 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Chestertown Street Address Deceased's Residence
Manner of Death 0 Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
1.
' Circumstances Investigation
Medical Certifier Name Title
Lynn M. Keil, W.
fi' Address
f 161 Carey Road Queensbury, NY 12804
PAth Death Certificate Filed District Number Register Number c
<9? City, Town or Village (y -�S/ f 7 / i
b
°' Date or Cre atory ,�-�
❑Burial /D
12/31/2018 //7-6 /-P ' ( '-'/ 4/c61e-,
❑Entombmen i(Qt Address ✓� �� /7 9� � S j��, -4/7
®CremationX f
Date Place emoved /
`,;❑ Removal and/or Held
and/or Hold Address
Date Point of
❑Transportation Shipment
,, by Common Destination
Carrier
r Date Cemetery Address
❑ Disinterment
t. Date Cemetery Address
r El Reinterment 1
'° Permit Issued to Registration Number
A', � Name of Funeral Home Barton-McDermott Funeral Home Inc. 00141
,�?
��� Address
1, 9 Pine St/P.O. Box 455 Chestertown NY 12817
4;; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
rt'
, 1 Permission is hereby granted to dispose of the human remains desrii d above as indicated.
Registrarof Vital Statistics
Date Issued I�-3 l-a a►� J J clk.lA1Ct
k (sign u )
District Number Sfo .c9- Place a(_.0a ciC CGiesT
' : I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition►1-)I-Iy Place of Disposition Dirk, VGt ClentioCY
(address)
(section) (lot number) (grave number)
!, Name of Sexto ,r Person in Charge of Premises Tam e..Y irer_S
(please print)
Signature ten Title Lre'r"q+°r
(over)
DOH-1555(02/2004)