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Barnes, Elizabeth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elizabeth Barnes Female Date of Death Age If Veteran of U.S.Armed Forces, 03/05/2020 90 Years War or Dates F- Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address 325 Broadway Apt 30, Fort Edward Town,New York 12828 W Manner of Death © Undetermined Pending Natural Cause Accident Homicide Suicide g W Circumstances Investigation V W Medical Certifier Name Title Jamie Bovair NP Address 325 Main Street,Hudson Falls,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 18 ❑Burial Date Cemetery,Crematory or Facility Name 03/07/2020 Pine View Crematorium Entombment Address WICremation Queensbury Town,New York ❑Donation QRemoval Date Place Removed and/or and/or Held Cn F- Hold Address O N Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number 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 or to Whom F Remains are Shipped,If Otherthan Above 2 Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/06/2020 Registrar of Vital Statistics Aimee Mahoney(Electronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 3—7- ZpZp Place of Disposition ; Q �, eo a / W 2 (address W N Q (section/ n / y(lot umber) (grave number/ Name of Sexton or Person in Cha a of Prem' es /! �f<1 Ii+O.dQ G lt/op� (please print) Z { W Signature / Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) w 0 1 1%"1 9 6 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#