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Swan, Marjorie Thomas
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marjorie Thomas Swan Female Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2021 99 Years War or Dates E.. Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death ©Natural Cause ciAccident El Homicide Suicide 0 Undetermined 0Pending 111 V Circumstances Investigation WCt Medical Certifier Name Title Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 7 Burial Date Cemetery,Crematory or Facility Name 02/25/2021 Pine View Crematorium 0 Entombment Address 0 Cremation Queensbury Hamlet,New York El Donation Removal Date Place Removed �;„ and/or and/or Held N Hold Address 0 CI. Date Point of U1❑Transportation O 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 2 Address LE W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/24/2021 Registrar of Vital Statistics 7(itth[een C.Lorah(Efectronica(tySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition LI7s I ZJ Place of Disposition ns If.,... � r4_, Ill 2 (address) W 2 (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises rbt-..FIL_ Svw,I rr z (p se print) W Signature tr Title rill‘w DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014580 Receipt Human remains of f delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#