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Bedell, Roma M
g�tb 1 NEW YORK STATE DEPARTMENT OF HEALTH r Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Roma M.Bedell Female Date of Death Age If Veteran of U.S.Armed Forces, 10/05/2021 94 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Chester Town Warren Street Address 39 Hayes Road,Chester Town Warren,New York 12817 p Manner of Death Natural Cause 0 Accident Eli Homicide 0 Suicide Undetermined El Pending Circumstances Investigation UUi Medical Certifier Name Title David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 16 ElBurial Date Cemetery,Crematory or Facility Name 10/06/2021 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed -8 El and/or and/or Held - Hold Address 0 O. Date Point of fA ❑Transportation b by Common Shipment 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 H Remains are Shipped,If Other than Above a Address IC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/06/2021 Registrar of Vital Statistics Windy Conway(E.Cectronicalfy Signed) (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: Z Date of Disposition /C�l i� Place of Disposition ��a�i` �... t� 2 (address) W Lij (section) A (lot number) (grave number) Name of Sexton or Person in Charge of P miser S +n t6� Z (p se print) W Signature Title (g'a DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20- 1 �; ! �. a f, Pine View Cemetery Representing the funeral home named on buril,permit Official Funeral Directors Reg.or License#.i .-)__ `a