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Erickson, Chris Anna Antoinette NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Christi-Anna Antoinette Erickson Female Date of Death Age If Veteran of U.S.Armed Forces, 05/13/2021 82 Years War or Dates F— Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 128 Olmstedville Road,Chester Town Warren,New York 12860 p Manner of Death ©Natural Cause 0 Accident El Homicide El Suicide El Undetermined El Pending IIJ 0 Circumstances Investigation W Medical Certifier Name Title O Daniel Kredentser MD Address 391 Myrtle Avenue 2,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 7 ElBurial Date Cemetery,Crematory or Facility Name 05/15/2021 Pine View Crematorium 0 Entombment Address 0 Cremation Queensbury Hamlet,New York Donation ZO Removal Date Place Removed - and/or and/or Held F.- Hold Address U) 0 Ga. Date Point of UN ❑Transportation Shipment 0 by Common 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 E— Remains are Shipped,If Other than Above 2 Address Cr IW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/14/2021 Registrar of Vital Statistics Minify Conway(E(ectronica1tySigned) (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: W Date of Disposition 5=-/5"--2,02 I Place of Disposition A Am V f4L) ('!-cry, -/ (address, / W Ce (section) > ^(lot number) (grave number) SName of Sexton or Person in Charge Premises /S Y"i A A--. A/e z (please print) W 4c54— Signature^ fy4i �/� Title ®��'� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of I delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ; _, `', -7 1