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Stone, Dorothy Ann 1- .li) A 1 t Lie i NEW YORK STATE DEPARTMENT OF HEALTH _ \ Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Dorothy Ann Stone Female Date of Death Age If Veteran of U.S.Armed Forces, 06/08/2023 85 Years War or Dates ZPlace of Death Hospital,Institution or ICJ City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Manner of Death El Natural Cause ❑Accident 0 Homicide Suicide Undetermined ElPending W v Circumstances Investigation 111 Medical Certifier Name Title Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 286 Burial Date Cemetery,Crematory or Facility Name s' 06/09/2023 Pine View Crematorium Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed F and/or and/or Held - Hold Address 0 a. Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment 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 F-- Remains are Shipped,If Other than Above 5 Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/09/2023 Registrar of Vital Statistics Megan Noln(f(ectronicaCCy Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Il— � WDate of Disposition 6-40,to 3 Place of Disposition j ,l2 IA Cr ,c.,i r 2 (addroo W CO CC (section) of number) (grave number) 0 Name of Sexton or Person in Charge Premises k'tiY >>✓J [x� Z (please print/ W Signature �' e � 2 / Title Y @TTi DOH-1555(07/18)p 1 of 2 V j JJ Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named/on burial permit Official Funeral Directors Reg.or License#