Buchanan, Charles H. r
-- I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
j30
Bureau of Vital Records
Name First Middle Last Sex
Charles H.Buchanan Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/26/2021 83 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Chester Town Warren Street Address Route 8,Chester Town Warren,New York 12817
tp Manner of Death XINatural Cause El Accident D Homicide El Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Lynn Keil PA
Address
1340 State Route 9,Lake George Town,New York 12845
Death Certificate Filed District Number Register Number
City,Town or Village Chestertown 5652 2
EiBurial Date Cemetery,Crematory or Facility Name
02/04/2021 Pine View Crematorium
ElEntombment Address
0 Cremation Queensbury Hamlet,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
i- Hold Address
0
Q. Date Point of
d) ❑Transportation
b by Common Shipment
Carrier Destination
ElDisinterment 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
F- Remains are Shipped,If Other than Above
a Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/01/2021 Registrar of Vital Statistics Mindy Conway(ECectronicaaySigned)
(signature)
District Number 5652 Place Chestertown, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Z(31 X
Place of Disposition
iI(address)
W
(section) (l umber) (grave number)
8 Name of Sexton or Person in Charge of Premises rt, ' ��Alt
(please pipit)
W Signature Title G 1,41
DOH-1555(07/18)p 1 of 2
1
Public Health Law Sec. 4145(2b)- J a 1 4.s 1 4
I
Receipt 1
Human remains of .delivered on , 20
e ; ,\ry
Pine View Cemetery Representing the''funeral home named on burial permit
Official Funeral Directors Reg.or License#. " ,.