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Atkinson, Charles Thomas r . _- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Thomas Atkinson Male Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2020 66 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address 14 Hudson Avenue 503, Glens Falls, New York 12801 V Manner of Death ©Natural Cause Accident Homicide SuicideLi Undetermined Pending Circumstances Investigation QW Medical Certifier Name Title Sharon Shannon NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 551 Burial Date Cemetery,Crematory or Facility Name 12/05/2020 Pine View crematorium El Entombment Address Cremation Queensbury Hamlet,New York EjDonation Removal Date Place Removed F and/or and/or Held N Hold Address 0 Cl)CL ll Transportation Date Point of 5 by Common Shipment Carrier Destination 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 St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2020 Registrar of Vital Statistics W96ert,1.ndrew Curtis(E(ectronica1TySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Ja v=zvZe Place of DispositionUJ 2 (address) W CC (section) ---; (lot number) (grave number) 8 Name of Sexton or Person in Cha f Premis I�LJ�/07o 6 f' y/ae Z (please print) iW Signature 'ice—�8 Title PP.Jd-D DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) . 0 1.426 6 Receipt Human remains of 7 'delivered on . , 20 +` - Pine View Cemetery Representing the f}inerar horde named on burial permit Official Funeral Directors Reg.or License#,/' +,_ ". -,-/*