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Kinney, Frances E
03 NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Frances E.Kinney Female Date of Death Age If Veteran of U.S.Armed Forces, 07/23/2021 72 Years War or Dates Place of Death Hospital.Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death ©Natural Cause El Accident ❑Homicide El Suicide El Undetermined El Pending W Circumstances Investigation E• 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 25 ElBurial Date Cemetery,Crematory or Facility Name 07/23/2021 Pine View Crematorium EjEntombment Address ©Cremation Queensbury Town,New York ' Donation 0 ❑Removal Date Place Removed - and/or and/or Held - Hold Address t/1 0 a. Date Point of U? ❑Transportation Shipment 8 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 Remains are Shipped,If Other than Above • Address IW LL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/23/2021 Registrar of Vital Statistics 7(/tthleen C.Gorah(E(ectronica1ly Signed) /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 7-2 V- oil Place of Disposition ; ,)QA C > C 4.-/Gress r i. 111 (add W (section) (lot numbe (grave number) Name of Sexton or Person in Cha of Premises 13Yll111G.st 1� tjOGG! (please print) W Signature > ! �' = Title Oer:%�1 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 6 - f..i Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on b.Lrial permit Official Funeral Directors Reg.or License#,- ' '