Porter, Judy M (-----
(ci
wit
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Judy M.Porter Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/18/2022 72 Years War or Dates
t~ Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
pManner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
QMedical Certifier Name Title
Came Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 92
Burial Date Cemetery,Crematory or Facility Name
12/20/2022 Pine View Crematorium
Entombment— Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
N Transportation
p 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
H 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 12/19/2022 Registrar of Vital Statistics Aimee£Yda(wney(ECectronicaffySigned)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 12 I ti 17Z Place of Disposition .4 ( v*O
2 (address)
W
CC (section) 4. cn,,,(lot number) (grave number)
8 Name of Sexton or Person in Charge of miser
S,„„,-,
Z (pane print)
W Signature Title rbrisnifilV
g
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0
Receipt
Human remains of delivered on , 20 --
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#