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Barber, Daniel t I `r NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Flermit Name First Middle Last Sex Daniel Thomas Barber Male 3 Date of Death Age If Veteran of U.S. Armed Forces, January 22, 2017 61 War or Dates g. Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death rnILI, .i Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending u, Circumstances Investigation ig Medical Certifier Name Title David Foote, Dr. Address j 340 Main St. Hudson Falls, NY 12839 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 5 5 ❑Burial Date Cemetery or. ry /� January 24, 2017 /( V �e W C ' ❑Entombment Address e-N ,�/',, © lXl�/YtzeCremation r R 0 Va -A/.S`,Juy Date Place Removed) z❑ Removal and/or Held and/or Address Hold Date Point of 44, 0 El TransportationShipment by Common Destination Of Carrier ❑ Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 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 1 I z y / / 7 Registrar of Vital Statistics W (signature) District Number 5601 Place 6 \V S, bJ ' r I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 01/24/2017 Place of Disposition en y,,, f n,ing{ac1;M ,- -, (address) (section) j(lot number) (grave number) Name of Sexton or Person in Charg of Premises 7l�r, t�+l ' ,/, (phase print) Signature [-t ,e, Title CROVirDP- 9 (over) DOH-1555 (02/2004)