Loading...
Gould, Mary Louise NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Louise Gould Female Date of Death Age If Veteran of U.S.Armed Forces, 11/23/2023 84 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek p Manner of Death Natural Cause Accident Homicide OSuicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title C Jennifer Donovan DO 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 50 Burial Date Cemetery,Crematory or Facility Name 11/25/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Hamlet,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address O d. Date Point of Cl)❑Transportation (3by Common Shipment Carrier Destination Date Cemetery Address nDisinterment 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 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/24/2023 Registrar of Vital Statistics jean M Comstock(ECectronicatty 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: F- /IZ Z Date of Disposition gz0z 3 Place of Disposition � i>Je ✓;e_viiI C!-en/<, 2 (address) W CC N (section) (lot number) (grave number) 0 Name of Sexton or Person in Cha of re • es t'r�/MD�-.b Z > (please print) W Signature / Title � �� rs— DOH-1555(07/18)p 1 of 2 C1 -7698 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#