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Holcomb, Barbara Alice NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Alice Holcomb Female Date of Death Age If Veteran of U.S.Armed Forces, 03/02/2020 77 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Q Manner of Death ©Natural Cause Accident Homicide Suicide Ej Undetermined Pending lu Circumstances Investigation Ul Medical Certifier Name Title Nawed Siddiqui MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 106 Burial Date Cemetery,Crematory or Facility Name ❑Entombment 03/05/2020 Pine View Crematory Address X❑Cremation Queensbury Town,New York Donation zRemoval Date Place Removed H and/or and/or Held as Hold Address a IL Date Point of 0 ❑Transportation c3 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/04/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILJ Date of Disposition 31 I' ZO� Place of Disposition rdt, (tv.. a (address/ w cc (section) (tot number/ (grave number) Name of Sexton or Person in Charge of Premises tri1 l , M,14h (Piiedse print) Signature Title � M DOH-1555(07/18)p 1 of 2 N' !R Public Health Law Sec. 4145(2b) 013_,8 i3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#