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Bystrak, Joseph Henry . 4 ))(0 • ^^"t'T"TE^L"ARTMENT OF HEALTH Burial - Transit Permit Dui-eau of Vital Records ---------------- Name First Middle Last Sex Joseph Henry Bystrak Male Date of Death Age If Veteran of U.S.Armed Forces, 04/06/2023 72 Years War or Dates F,. Place of Death Hospital,Institution or Z-City,Town or Village Chester Town Warren Street Address 2 Vetter Avenue,Chester Town Warren,New York 12817 pManner of Death IZI Natural Cause Accident Homicide Duicide FlUndetermined Pending W Circumstances Investigation WMedical Certifier Name Title 0 Sarah Durkee 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 , 4 Burial Date Cemetery,Crematory or Facility Name 04/07/2023 Pine View Crematorium ©_Entombment Address Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed - and/or and/or Held H Hold Address N 0 Date Point of U)DTransportation Shipment B by Common 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 i— Remains are Shipped,If Other than Above 2 Address It W n' Permission is hereby granted to dispose of the human remains described Ph w'AQ infli"*eFl Date Issued 04/06/2023 Registrar of Vital Statistics Mindy Conway(ECectranicaffySigned) (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: z y v`e) / - Date of Disposition ZV23 Place of Disposition /,�� t /` k .,15 W (micheysy W CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Cha of Pre ' - ,14/�d /^0� ) J Z (please print) W Signature Title 0(re 4.:10r DOH-1555(07/18)p 1 of 2 s1. Public Health Law Sec. 4145(2b) Receipt I i Human remains of delivered on , 20 Pine View Cemetery Representing the funeral dome named on burial permit Official Funeral Directors Reg.or License#,'