Barber, Arthur 4 -
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Arthur Brumagen Barber Male
Date of Death Age If Veteran of U.S. Armed Forces,
3/29/2018 23 War or Dates _ n/a
Place of Death Hospital, Institution or
Z City, Town or Village Lake George Street Address 2 Prospect Street
pManner of Death in Natural Cause n Accident ❑Homicide Suicide Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
G Terry Comeau,Coroner
Address
Lake George,NY
Death Certificate Filed District Number Register Number
City, Town or Village Lake Georg
®Burial Date Cemetery or Crematory
❑Entombment April 4,2018 Pine View Cemetery
Address
_n Cremation —_ _ -_ uaker F oa.d>Queensburv.NYJ 2804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
co ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
(�Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
a.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 0 i})Q ))/ p/g Registrar of Vital Statistics 1C.9.112a . � 111*sd
J (signatdre)
District Number 56 a 0 Place Village of Lake George,NY 12845
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 4/4/201 8Place of Disposition Pine View Cemetery 21 Quaker Rd QSRY
W (address)
Erie 50A 1
(s ) (lo umber) (grave number)
in •
Name of S ton or Person in Charge of Premises &.' /E L. (O E[7 E 57
W (pl ase print)
Signatur -e Title
(over)
DOH-1555(02/2004)