Mueller, Joan Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH 1 e3Z
Bureau of Vital Records Burial - Transit Permit
Name First
Joan Elizabeth Mueller Middle Last Sex
Date of Death Age If Veteran of U.S.Armed Forces, Female
07/04/2022 79 Years
i.. Place of Death War or Dates
WCity,Town or Villa a Hospital,Institution or
g Glens Falls Street Address Glens Falls Hospital
o Manner of Death
Natural Cause ❑Accident Ei Homicide ❑Undetermined
Suicide ❑Pending
0 Medical Certifier Name Circumstances Investigation
Marcille Labban Title
MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number
City,Town or Village 5601 Register Number
Burial Date 353
Cemetery,Crematory or Facility Name
Entombment 07/06/2022 f Pine View Crematorium
Address
aCremation Queensbury Town,New York
Donation
g❑Removal Date Place Removed
i„. and/or and/or Held
N Hold Address
WOTransportation
Date Point of
by Common I Shipment
Carrier Destination
Date Cemetery Address❑Disinterment
Reinterment Date Cemetery Address
Permit Issued to
Name of Funeral Home Barton-Mcdermott Funeral Home Inc Registration Number
Address 00141
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
IF— Remains are Shipped,If Other than Above
a Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2022 Registrar of Vital Statistics Mtegan Nolin(E(ectronicaITySigned)
(signature)
District Number 5601 Place City Of Glens Falls
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z "tint
W Date of Dispositon 7f Ip IZZ Place of Disposition
(address)
W
)¢ (section) (/pt number) (grave number)
eta mcorsexton or Person in Charge of Premises rq �,
Z j�� (ease print)
W Signature — — - Title Citknni tv'�
DOH-i555 to7hh1 p l o{i
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ri r)
Public Health Law Sec. 4145(2b)
Receipt
, •
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• c, ,
Human remains of ," • ri deliyer,d on , 20
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Pine View Cemetery Representing the funeral home name ,,on,bur*1-penpit
Official Funeral Directors Reg.or License#