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Reynolds, Barbara White NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Jean Reynolds Female Date of Death Age If Veteran of U.S.Armed Forces, 02/06/2020 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 26 Crownwood Lane,Queensbury Town, New York 12804 W Manner of Death Undetermined Pending W � Natural Cause �Accident � Homicide �Suicide � � g C.) Circumstances Investigation W Medical Certifier Name Title Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 22 ©Burial Date Cemetery,Crematory or Facility Name 02/11/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held F= Hold Address N O IL Date Point of (A Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address JE]Reinterment Date Cemetery Address Permit Issued to 7 Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/07/2020 Registrar of Vital Statistics CarolnexYegard Bader(EYectronicaffySoned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f WDate of Disposition Place of Disposition LU (address) W N (section) (tot number) /grave number) CName of Sexton erson in Charge of Premises Z (please print) W Signature U - �`^�'�'� Titl DO H-1555(07/18)p 1 of 2 `public Health Law Sec. 4145(2b) b 10 6 7 Receipt i Human remains of C —A �5 l u delivered on. r 1�A��, %.Er' , 20 r� i� — ' �. 1 Pine View Ce !!f Representing the funeral home named on burial�iermit Official Funeral Directors Reg.or License# ";� Reynolds (White) NAME Barbara White (Reynolds) Age: 79 Lot Owner: Barbara White (Reynolds Lot# 69A Erie Grave# 1 Case: Concrete Died: 2/6/2 0 2 0 Interred: 2/1 1 /2 0 2 0 Funeral Home: Regen Denny Staf f ord Cemetery:pine View