Barden, Donald NEW YORK STATE DEPARTMENT OF HEA/-I
Vital Records Section '" Burial - Transit Permit
Name First Middle Last Sex
Donald Edward Barden Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/03/2017 91 Years War or Dates WWII
Place of Death Hospital, Institution or
City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death 17g1Natural Cause ❑Accident Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Edit Masaba MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 5750 35
❑Burial Date Cemetery or Crematory
12/04/2017 Pine View Crematory
['Entombment Address
Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
CI
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/05/2017 Registrar of Vital Statistics She1(ey Mcd rnon ElectronicaaySigned'
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 't/r.( Place of Disposition '04,V'-'1
(address)
(section) (lot number) r (grave number)
Name of Sexton or Person in Charge of Prem. es j.(Ilsei print) svolit
Signature -� Title II'i 1°11°L"
(over)
DOH-1555 (02/2004)