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Barton, David A
it loll- - NEW YORK STATE DEPARTMENT OF HEALTH g Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex David A.Barton Male Date of Death Age If Veteran of US.A forces, 05/10/2021 92 Years War or Dates 1946-1949 Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc pManner of Death ©Natural Cause DAccident 0 Homicide 111Suicide Undetermined 0 Pending W 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 288 Burial Date Cemetery,Crematory or Facility Name 05/12/2021 Pine View Crematory Entombment Address aCremation Queensbury Town,New York ElDonation ZO ❑Removal Date Place Removed and/or and/or Held I- - Hold Address 3 0 Date Point of CA ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Edward L Kelly Funeral Home 00519 Address PO Box 548,Schroon Lake,New York 12870 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/10/2021 Registrar of Vital Statistics 9ofinTau franck(E(eatronicarySigned) (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: ''` � Z Date of Disposition Ei jZ Ili Place of Disposition "'^'I!__ lJ 4---... COLLI 2 (address) ILI CC (section) (/ot mbar) (grave number) OP. a l� 0 Name of Sexton or Person in Charge of Prem. es (please 4 W !f SignatureZ Title a ' DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) ` 1 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#