Hammond, David J ULF J) 5Z CT
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David J Hammond Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/08/2022 83 Years War or Dates
l,... Place of Death Hospital,Institution or
WCity,Town or Village Chester Town Warren Street Address 7797 US-9 Route,Chester Town Warren,New York 12860
p Manner of Death 0 Natural Cause []Accident 0 Homicide Suicide Undetermined Pending
W
v Circumstances Investigation
WW Medical Certifier Name Title
Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Chester District Number Register Number
City,Town or Village 5652 9
Burial Date Cemetery,Crematory or Facility Name
07/09/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ o Hld Address
CO
0
ld. Date Point of
CO❑Transportation
a by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
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
—. Remains are Shipped,If Other than Above
a Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/08/2022 Registrar of Vital Statistics Mindy Conway(EfectronicalTy Signed)
(signature)
District Number 5652 Place Town Of Chester
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7-9 zjZL Place of Disposition r► ;0P LA re?at) P rem 4,-Ip /t-
tIJ
2 (address) 1
W
(I) (section) (lot number) (grave number)
SName of Sexton or Person in Char of Premiss �cz,/i o,0 A }i at7j
Z /,/ (please print)
W Signature 4! LT/ Title D6
DOH-1555(07/18)p 1 of 2
. #asuaonJO-2aN sioloalm'mound ImPUJO
pauuru tuog te.lounj.acp 2upuosaidaa Xiapump main avid
OZ uo pan.Allap.„. . . swum.' uuumll
/.71 1,",•;/, /:I • .
•
idp3oN
(qz)stit *Dos mui 4uP0H Dllqnd