Loading...
Smith, Jane Ellen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jane Ellen Smith Female Date of Death Age If Veteran of U.S.Armed Forces, 11/08/2023 89 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 40 Delaney Drive,Horicon Town, New York 12815 0 Manner of Death El Natural Cause Accident Homicide ri Suicide Undetermined ri Pending Circumstances Investigation W Medical Certifier Name Title O Judy Podziewski NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Horicon District Number Register Number City,Town or Village 5654 8 Burial Date Cemetery,Crematory or Facility Name 11/09/2023 Plne View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of (I)❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address nDisinterment nReinterment 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 S Address fZ W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/09/2023 Registrar of Vital Statistics 4CristaLWood(ECectronicaIfySigned) (signature) District Number 5654 Place Town Of Horicon I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition it l i) I Z3 Place of Disposition I cr `(bbM011/Q:0—N. W 2 (address) W (section) (i number) (grave number) Qg Name of Sexton or Person in Cha a of Premises �� `'' (p4ase print) Z W Signature Title (�F.n+ATO I. DOH-1555(07/18)p i of 2 41 54 Public Health Law Sec. 4145(2b) Receipt r" Human remains of delivered on , 20- , /N � 7 Pine View Cemetery Representing the funeral home named pq bul'ial,permit Official Funeral Directors Reg.or License#,6