Pignataro, Anna 4 43L1,()
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NEW YORKSTATE DEPARTMENT OF HEALTH 4 :} Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Anna Pignataro Female
Date of Death Age If Veteran of U.S.Armed Forces,_
10/23/2022 76 Years War or Dates ,
1.. Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address 110 Hudson Street,Johnsburg Town, New York 12843
WW Manner of Death
a Natural Cause Accident 0 Homicide Suicide FlUndetermined aPending
V I—ICircumstances Investigation
LU Medical Certifier Name Title
Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Johnsburg District Number Register Number
City,Town or Village 5655 26
BurialE
Date Cemetery,Crematory or Facility Name
10/24/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
4. Date Point of
U)❑Transportation
a by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment 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
cr
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/24/2022 Registrar of Vital Statistics jean M Comstock(E(ectronica(ry Signed)
(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:
Z
Z Date of Disposition /p 125 I t_ Place of Disposition 1L-I V_, ( j(0 --
2 (address)
W
N
CC (section) ((o number) (grave number)
SName of Sexton or Person in Char e o emises rF' t tt
Z ( ease print)
W Signature Title �1�'� 1�►�
DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b)
Receipt
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Human remains of - 1' (r !' -'delivered on , , , 20T
Pine View Cemetery Representing the funeral home named 9n.bu> al.permit
Official Funeral Directors Reg.or License# l