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Barrette, Violette NEW YORK STATE DEPARTMENT OF HEALTH '• (m' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Violette L . Barrette F Date of Death Age If Veteran of U.S. Armed Forces, June 8 , 2006 03 War or Dates -. Place of Death Town of Fort Edward Hospital, Institution or Fort Hudson Nursing Home II City, Town or Village Street Address 0 Manner of Death Undetermined Pending ©Natural Cause [�Accident �Homicide �Suicide � � to Circumstances Investigation ui Medical Certifier Name Title 0 Philip J . Cara Jr. liD Address 327 Broadway, Fort Edward , NY 12828 Death Certificate Filed District Number Register Number City, Town or Village Fort Edward .5-7i-- 3 ❑Burial ( Date Cemetery or Crematory June 9 , 2006 Pine View Crematory []Entombment Address ['Cremation Quaker road , Queensbury, Ny 12804. Date Place Removed Z Removal and/or Held 2❑and/or Address I= Hold U) 0 Date Point of gi Q Transportation Shipment 0 by Common Destination Carrier Date - Cemetery Address Q Disinterment Reinterment Date Cemetery Address Permit Issued to Re istration Number Name of FuneralHomNe. B. Kilmer Funeral Home O12 Address 82 Broadway Fort Edward , NY 12828 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped, If Other than Above 2 Address cr W fl` Permission is he eb granted to dispose of the human r ains described abov as indicated. Date Issued 6 Q� Registrar of Vital Statistic J7'Z. ��- (signature) District Number 755 Place /in i� (arid' c 1_ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z �A lE1 Date of Disposition G._/i-.0 Cr Place of Disposition �)tN r ti/ ,r Id G R EA-2 q 1- lZ_t 0 v l 2 (address) la Ul ir (section) (lot number) (grave number) Q Name of Sexton or Person in Charge of Premises G `ifz..1 CAlq AJ-i- (please print) iti Signature �Title � i fi s'G l 0 (over) DOH-1555 (02/2004)