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Hart, Linda C
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Linda C.Hart Female Date of Death Age If Veteran of U.S.Armed Forces, 11/24/2021 74 Years War or Dates Place of Death Hospital,Institution or ZCity,Town or Village Chester Town Warren Street Address 167 Old Schroon Road,Chester Town Warren,New York 12860 p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined n Pending U Circumstances Investigation W Medical Certifier Name Title G Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 20 ❑Burial Date Cemetery,Crematory or Facility Name 11/30/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ElDonation ❑Removal Date Place Removed and/or and/or Held H Hold Address O O. Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom — Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics Mindy Conway(ECectronica1TySigned) (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:W Date of Disposition /2 Z2/ / Place of Disposition tJ e (iiie t) 6- ze / 2 (address) J W CC N (sedio (lot umbe (grave number) Name of Sexton or Person in Cha of Premi s ddplease print/ INertib W Signature < ' Title kdr DOH-1555(o7/t8)p 1 of 2 J _ . .. 5 3 8 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#