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Campp, Barbara Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Ann Campp Female Date of Death Age If Veteran of U.S.Armed Forces, 01/21/2020 62 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Valatie Village Street Address Barnwell Nursing And Rehabilitation Center p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Kathleen Steiger NP Address 3230 Church St,Valatie Village,New York 12184 Death Certificate Filed District Number Register Number City,Town or Village Valatie Village 1023 4 Burial Date Cemetery,Crematory or Facility Name 01/24/2020 Pine View Crematorium Entombment Address 0 Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held H N Hold Address O IL Date Point of N Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Retration Number gis Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom I— Remains are Shipped,If Other than Above Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/24/2020 Registrar of Vital Statistics Bar6ara,4nn Tischer(E(ectronicallySigner) (signature) District Number 1023 Place Valatie Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H WDate of Disposition -7-1-20W Place of Disposition P .e 2 (ad ess) W N (section) r (lotnumber) (grave number) Q !J1 Name of Sexton or so n Charge of Premises / wit e Z (ple se print) W Signature Title G �° DO H-1555(07/18)p 1 of 2 013975 Public Health Law Sec. 4145(2b) z4. Receipt Human remains of t, E a delivered on - , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# O # e