Granger, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara J. Granger Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 4, 2011 79 War or Dates
aF Place of Death Hospital, Institution or
tiZ City, Town or Village Glens Falls Street Address Glens Falls Hospital
:p Manner of Death f Natural Cause Accident I I Homicide Suicide Undetermined Pending
Ill Circumstances Investigation
W Medical Certifier Name Title
o E v F(vi 1 os 1" , -Pau t 5 ivb.
Address j
Death Certificate Filed District Number R lumber
City, Town or Village Glens Falls 5601 1
❑X Burial Date Cemetery or Crematory
December 9, 2011 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
6 by Common Destination
Carrier
Disinterment Date [—Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2' Address
CZ
C.
Permission is hereby granted to dispose of the human remains desccrrii ed abo as ' ated.
Date Issued / OG 2D/l Registrar of Vital Statistics .r�� c �r
at / 9 0'
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 1 2/9/1 1 Place of Disposition Pine View Cemetery
2 (address)
III
U) Erie 36 B 2
CL (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Michael Genier
W9./Z w
Signature �� (please print)
-.-iTitle Superintendent
(over)
DOH-1555(02/2004)