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Brann, Barbara I ;# A;-, NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Barbara Warner Brann Female >:'Date of Death Age If Veteran of U.S. Armed Forces, iiii January 12, 1999 87 War or Dates ffi Place of Death Hospital, Institution or ai City, T 900041060UOCK Glens Falls Street Address Fden Park Nursing Hare ::::::::Manner of Death Undetermined Pending ]Natural Causes�Accident 0 Homicide 0 Suicide Circumstances ❑ Investigation ffi Medical Certifier Name Title Robert L. Evans DO Address 3 Irongate Center, Glens Falls, NY 12801 : .Death Certificate Filed District Number Register Number Mii City, Tg ( Glens Falls . D 0 1 1 9 Date i Cemetery or Crematory © Burial I 109 9 9 Pine View Cemetery ❑ Cremation Address Tn of Queensbury, NY Date Place Removed ❑ Removal and/or held and/or hold Address Date Point of ri❑ Transportation by Shipment Common Carrier Destination Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment ::::::Permit issued to Registration Number ':::: Name of Funeral Firm Carleton Funeral Hare Inc. 00313 iiiiAddress P.O. Box 67, 68 Main St. , Hudson Falls, N.Y. 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above `:>> Address lit Permission is hereby granted to dispose of the human remains described abov a ind.cate . ` Date Issued I 112 1(49 Registrar of Vital Statistics (Signature) inl District Number 5 60 ) Place_ Glens Falls, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition4/10/99 Place of Disposition Pine View Cemetery , Queensbury , NY (address) ah-Ta-Wah 523 5 (Section W (Lot Number) (Grave Number) Name of Sextoiu r Person in Charge of Premises Rodney G . Mosher //J (Please Print) Signature A: �4," Title Superintendent DOH-1555 (10/89) p. 1 of 2 VS-61