Malone, K. Teresa NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
K.Teresa Malone Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/19/2021 97 Years War or Dates
i.. Place of Death Hospital,Institution or
WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
0 Manner of Death NI NaturalCause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Diane Westbrook NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 154
ElBurial Date Cemetery,Crematory or Facility Name
02/20/2021 Pine View Crematorium
ElEntombment Address
ElCremation Queensbury Hamlet,New York
ElDonation
ElRemoval Date Place Removed
and/or and/or Held
f-N Hold Address
0
to Transportation Date Point of
a by Common Shipment
Carrier Destination
EIDisinterment 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
i— Remains are Shipped,If Other than Above
a Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/19/2021 Registrar of Vital Statistics John Pau(Franc((ECectronicafySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IN
W 'Date of Disposition ,,7-2i7--g j Place of Disposition f F n!C. i1 i �;�; E'r-T-,n
2 (address)
CO
Lu
(section) (lot number)A (grave number)
/5
Name of Sexton or Person in Cha e of Premis ew+sie d d r< ijcotrii
(please print)
W Signature e'' Title d e{f-Y4
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 5 R
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#