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Kearney, Judith D.
�z NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Judith D.Kearney Female Date of Death Age If Veteran of US.Armed Forces, 06/22/2021 81 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 72 Birchwood Drive,Chester Town Warren,New York 12817 p Manner of Death ©Natural Cause El Accident ❑Homicide Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title 0 Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 8 Burial Date Cemetery,Crematory or Facility Name 06/25/2021 Pine View Crematorium ElEntombment Address ElCremation Queensbury Hamlet,New York ElDonation QElRemoval Date Place Removed and/or and/or Held Hold Address 0 a, Date Point of to Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 t~ Remains are Shipped,If Other than Above 2 Address IW a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/23/2021 Registrar of Vital Statistics Wintry Conway(Efectronica(CySigned) (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: Date of Disposition (P�j6'Jti Place of Disposition t�. IW 11 etb"—"- (ad ress) LU (section) (lot number) (grave number) Name of Sexton or Person in Charge• 'remises I h f 3v,, (pleasspprint) ' � W Signature Title DOH-1555(07/18)p 1 of 2 ) 9 Public Health Law Sec. 4145(2b) 148 8 Receipt • Human remains of • • • ' .1 delivered on • , 20 - • • Pine View Cemetery Representing the funeral home named on burial pe Official Funeral Directors Reg.or License# ,