Thornton, Barbara Chris NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Chris Thornton Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/26/2020 73 Years War or Dates
Place of Death tal,Institution or
Z City,Town or Village Queensbury Town treet Address 22 New Hampshire Avenue,Queensbury Town,New York 12804
W
Q Manner of Death RI Natural Cause Accident 1:1Homicide 1:1Suicide Undetermined Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed DistriVumber Register Number
City,Town or Village Queensbury 5657 1 56
Burial Date Cemetery,Crematory or Facility Name
03/30/2020 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
Donation
Removal Date Place Removed
and/or and/or Held
0 Hold Address
O
IL Date Point of
U) ElTransportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
IM
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2020 Registrar of Vital Statistics CarnCrne-Wi-fdgarde BarAer Signed)
(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:
W Date of Disposition 3131110 Place of Disposition
(address)
W
N (section) (lot number) (grave number)
IM
Name of Sexton or Person in Charge of Pre&ises
Z /p/e e print/
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) - 13 4
Receipt
Human remains of delivered on j' , 20
Pine View Cemetery Representing,tfie funfieral home named on burial permit
Official Funeral Directors Reg.or License#