Holford, Marilyn J (2) 4 - Ss3
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marilyn J.Holford Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/12/2022 73 Years War or Dates
1.._ Place of Death Hospital,Institution or
WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek
a Manner of Death a Natural Cause Accident El Homicide Suicide Undetermined riPending
LLI
U Circumstances Investigation
W Medical Certifier Name Title
CI James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 19
Burial Date Cemetery,Crematory or Facility Name
07/13/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
EiDonation
cl EiRemoval Date Place Removed
and/or and/or Held
H Hold Address
CO
0
Q. Date Point of
U)fTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
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
N Address
LIC
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/13/2022 Registrar of Vital Statistics jean 9K Comstock(ECectronicallySigned)
(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:
IH
z Date of Disposition '7IN hi, Place of Disposition .�n,,L,,. 4t-d..,,;
W
2 (address)
IL
CO
CC (section) .(lot number) (grave number)
gName of Sexton or Person in Cha a of Premises L tr
2 lt-,
ease print)
W Signature Title � �
DOH-1555(07/18)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 on burial permit
Official Funeral Directors Reg.or License#