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Davis, Joan 4Lg NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan Davis Female Date of Death Age If Veteran of US.Armed Forces, 08/18/2021 90 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare 0 Manner of Death ©Natural Cause 0 Accident El Homicide 0 Suicide 0 Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title O Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 54 ElBurial Date Cemetery,Crematory or Facility Name 08/19/2021 Pine View Crematorium 1pEntombment Address ©Cremation Queensbury Hamlet,New York ElDonation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of t/! ❑Transportation Shipment $ 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 1.. Remains are Shipped,If Other than Above 2 Address CC W u' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/19/2021 Registrar of Vital Statistics Shelley Mckgrnon(ECectronica1Ty Signed) /signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /� Date of Disposition 8110114 Place of Disposition .11._ ` riirOn L--- 111 2 (address) W CC (section) 4(lot number) (gram number) 8 Name of Sexton or Person in Charge of Premises as ,V— ._s• z L/l /Plea print) W OMB 2 Signature Title DOH-1555(07/18)p 1 of 2 1 5 099 Public Health Law Sec. 4145(2b) Receipt ./' Human remains of--4- .� . ✓' l'--'1 delivered on L / / ,,�' , 20241 -7 i , ' / Pine View Cemetery ,tepresenting the funerafhome named on burialpq rmit Official i Funeral Directors Reg.or License#./- 3