McNally, Brenda Viola NEW YORK STATE DEPARTMENT OF HEALTH '`- Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brenda Viola McNally Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/25/2022 80 Years War or Dates
i,., Place of Death Hospital,Institution or
Z City,Town or Village Minerva Town Street Address 7 Town Shed Road,Minerva Town,New York 12851
Ili
W Manner of Death 0 Natural Cause ❑
Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
t7 Kellie Valentine Coroner
Address
PO Box 132,Elizabethtown Town,New York 12932
Death Certificate Filed Town Of Minerva District Number Register Number
City,Town or Village 1557 3
EBurial Date Cemetery,Crematory or Facility Name
09/27/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
iiDonation
0L IRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
(I)IlTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Ei 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
H Remains are Shipped,If Other than Above
2 Address
EC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2022 Registrar of Vital Statistics `Theresa Fisk(ElectronicafySigned)
(signature)
District Number 1557 Place Town Of Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition 9 j7N(l t Place of Disposition •'.`.r,Vt r�
W g (address)
LU
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 0.r L._ `�.u,l'
Zp/ease print) /+
iW0 1%
Signature Title l �%
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt E
1l'
1 Human remains of f f f delivered on . , 20 '
Pine View Cemetery Representing the funeral home named pq burial.perr it
Official Funeral Directors Reg.or License#