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Winch, Peter A
tt g 17 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter A.Winch Male Date of Death Age If Veteran of U.S.Armed Forces, 09/24/2021 60 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Horicon Town Street Address 395 Valentine Pond Road,Horicon Town,New York 12860 ,LI p Manner of Death ©Natural Cause Accident ElHomicide El Suicide El Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Lynn Keil PA Address 1340 State Rt 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Brant Lake 5654 6 Burial Date Cemetery,Crematory or Facility Name 09/27/2021 Pine View Crematorium Entombment Address Cremation Queensbury Hamlet,New York Donation 0 ❑Removal Date Place Removed and/or and/or Held Hold Address ❑Transportation Date Point of 5 by Common Shipment Carrier Destination EIDisinterment 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 F . Remains are Shipped,If Other than Above 2 Address IC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/27/2021 Registrar of Vital Statistics 7Zrista L Wood(Electronica1ySigned) (signature) District Number 5654 Place Brant Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 61114111 Place of DispositionILI 2 (address) W (section) /j llot number) (grave number) 8 Name of Sexton or Person in Charge of Pre ' es �/t ij 't- Z (pie�print) ,/� W Signature 4�� Title Ol g �� DOH-1555(07/18)p 1 of 2 0. 5186 Public Health Law Sec. 4145(2b) Receipt Human remains of • , °• . '_ delivered on , 20 '. '.r r r:;• fife ,: /e.f,r. ,4. Pine View Cemetery Representing the'funeral home named on burial.permit Official Funeral Directors Reg.or License# f,