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Liipfert, Martha Murray illf.) I 50 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Martha Murray Liipfert Female Date of Death Age If Veteran of U.S.Armed Forces, 02/11/2023 83 Years War or Dates f— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 59 Surry Fields Drive,Queensbury Town,New York 12804 p Manner of Death ®Natural Cause ❑Accident Homicide Suicide Undetermined Pending Circumstances Investigation IUt1 Medical Certifier Name Title O Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 24 Burial Date Cemetery,Crematory or Facility Name 02/13/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation 0 El Removal Date Place Removed and/or and/or Held pa Hold Address 0 O Date Point of (n Transportation Shipment $ by Common Carrier Destination El Disinterment Date Cemetery Address pReinterment Date Cemetery Address Peermit 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 F. Remains are Shipped,If Other than Above a Address IE W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/13/2023 Registrar of Vital Statistics Carotine7Ci[fegarde Bar6er(E.[ectronicaQySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:w Date of Disposition 24 ly t't3 Place of Disposition `I i�.V -�7"�-- W (addles/ IW CC (section) (lot number) 1 (grave number) SName of Sexton or Person in Charge of Premises °v c� rt (plese print) Z W t!V Titl dim Signature e DOH-1555(07/18)p 1 of 2 1 _ Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 -' Pine View Cemetery Representing the funeral home named on burialertslit Official Funeral Directors Reg.or License# / .