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Lewis, Jo Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jo Ann Lewis Female Date of Death Age If Veteran of U.S.Armed Forces, 12/03/2023 80 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Horicon Town Street Address 13 Market Street,Horicon Town,New York 12815 Manner of Death Z Natural Cause Accident El Homicide ESuicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Cl 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 10 RBurial Date Cemetery,Crematory or Facility Name 12/05/2023 Pine View Crematorium Entombment Address ©Cremation Brant Lake Hamlet,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N O a Date Point of (I)❑Transportation p by Common Shipment Carrier Destination nDisinterment 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 Remains are Shipped,If Other than Above SS Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2023 Registrar of Vital Statistics JCrista L Wood(ECectronicallySigned) (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: l— Z Date of Disposition aIS1z3 Place of Disposition rros .J CRI. 1I7 tits W (address) W (section) ds(lot number) (grave number) Name of Sexton or Person in Charge of Premisesoi( ease print) Signature Lam' Title (1M DOH-1555(o7/18)p 1 of 2 11..7-7?8 Public Health Law Sec. 4145(2b) Receipt Human remains of = delivered on , 20 --k f Pine View Cemetery Representing the funeral home named on-burial.permit Official Funeral Directors Reg.or License# -