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Wakley, Barbara N.
4 151 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara N.Wakley I Female Date of Death Age If Veteran of U.S.Armed Forces, 02/09/2020 1 89 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Johnsbur Town Street Address Elderwood at North Creek p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town orVitlage North Creek 5655 5 Burial Date Cemetery,Crematory or Facility Name 02/10/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation ZO ❑Removal Date Place Removed p and/or and/or Held N Hold Address O a. Date Point of N Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address 10 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 101199 Address 6357 Nys Rte#30,Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom E— Remains are Shipped,If Other than Above 2 Address cc W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2020 Registrar of Vital Statistics K&Hem C La'ah(Ela#rmidly9g4 (sigf7aturel District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Z/1l 170 Place of Disposition ram, W (address) 2 W N (section/ (lot numbe (grave number) cc Name of Sexton or Person in Charge Premises Premises '' fit `� ease pri t/ W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) a 3 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named,on burial permit Official Funeral Directors Reg.or License# ' s