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Halliday, Carol Alvina LF NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Carol Alvina Halliday Female Date of Death Age If Veteran of U.S.Armed Forces, 07/07/2023 85 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek 0 Manner of Death Natural Cause Accident Homicide Suicide Undetermined ri Pending V Circumstances Investigation Ui Medical Certifier Name Title Suzanne Barth PA Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 24 Burial Date Cemetery,Crematory or Facility Name 07/08/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed - and/or and/or Held - Hold Address 0 Q. Date Point of U)❑Transportation CI Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address n l Reinterment 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 Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/07/2023 Registrar of Vital Statistics Jean M Comstock(ECectronicaay 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: H / W Date of Disposition 7 ��7Place of Disposition �e �i`e� 2 (address) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pr ise �I1 T 0112'/ Z (please print) W Signature Title DOH-1555(07/18)p 1 of 2 �� o .l, t 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#