Delczeg, Barbara Florence , LuF g5(-)e)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Florence Delczeg Female
Date of Death ' Age If Veteran of US.Armed Forces,
04/08/2022 82 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Johnsburg Town Street Address 493 River Road,Johnsburg Town,New York 12862
p Manner of Death 0 Natural Cause Accident Homicide OSuicide nUndetermined Pending
W Circumstances Investigation
V
W Medical Certifier Name Title
CI Christopher Mason DO
Address
100 Park St,Glens Falls,New York 12801
DeaAth Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 6
Burial Date Cemetery,Crematory or Facility Name View 041
09/2022 Pine Crematontrn
Entombment Address
•
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CA
0
0. Date Point of
CO ElTransportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
❑Disinterment
Rei nterme nt
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
a Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/08/2022 Registrar of Vital Statistics jean At Comstock((EIctrnmu rllySYrted)
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition / / -oZis Place of Disposition Y ` Ne (Jit,Lt.t) C��ina.-}p r,
2 , (address)
W
Q (sectiao p num / (grave number)
gName of Sexton or Person in Charge Prem. s �p rmb''lA Wood
z (please print/
�
W Signature ie6 4 "" Title f�ir� �(T1
A-7
DOH 1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of • delivered on / , 20
Pine View Cemetery Representing the funeral home named pn birial_pen it
Official Funeral Directors Reg.or License#