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Hofmann, John Matthew
#61`i NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex John Matthew Hofmann Male Date of Death Age If Veteran of U.S. Armed Forces, 01/28/2022 0 years War or Dates ,' Place of Death Hospital, Institution or CityIli , T9 IJ( r)A M( Glens Falls Street Address Glens Falls Hospital 0 Manner of Death©Natural Cause ❑Accident ❑Homicide 0 Suicide ❑Undetermined Pending lW Circumstances Investigation ill Medical Certifier Name Title Michele Wickert MD Address • 45 Hudson Ave Glens Falls, Ny 12801 • • Death Certificate Filed District Number Register Number City,T9171X9r AMOC Glens Falls 5601 1 ❑Burial • Date Cemetery or Crematory ['Entombment Pine View Cematory Address Cremation Queensbury, Ny • Date Place Removed ,g" Removal and/or Held and/or � Address N Hold 0: I Date Point of Clr Transportation Shipment . Et by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton- Mc Dermott Funeral Home, Inc. 00141 Address 9 Pine Street Chestertown, N Y 12817 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above a Address Cr Lu Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/02/2022 Registrar of Vital Statistics +� (signatur District Number 5601 Place Glans Falls t "`` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Ia Date of Dispositior,L-3-ot.oa.?., Place of Disposition p;t' , �;f,l� (JTet"10 i ' 9 (add ess) ta I (section) (lot number) (grave number) Name of Sexton o erson in Charge of Premises Te(m V (S sAft 3 2 (please print) 1: ! Signature Title C.ic,vhQ*r (over) DOH-1555 (02/2004) C1r I Public Health Law Sec. 4145(2b) Receipt Human remains of 191elivered on _. , 20 Fine View Cemetery Representing the funeral home named,.on burial]erruit Official Funeral Directors Reg.or License#