Prinz, Barbara NEW YORK STATE DEPARTMENT OF HEALTH 4 •
Bureau of Vital Records Burial - Transit Permi
Name First Middle Last Sex
Barbara A Prinz Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/23/2020 74 Years War or Dates
zPlace of Death Hospital,Institution or
City,Town or Village Corinth Town Street Address 377 Angel Road Lot 27A,Corinth Town, New York 12822
UJI
1p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
Q
Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Corinth 4553 13
Burial Date Cemetery,Crematory or Facility Name
04/25/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
zRemoval Date Place Removed
and/or and/or Held
F-(A Hold Address
O
Q. 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 Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
Ir
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/24/2020 Registrar of Vital Statistics Rose E Farr(Electronically Signed)
(signature)
District Number 4553 Place Corinth, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
W Date of Disposition _,ZCf/ S-2oy�Place of Disposition ' j �e-
2, (address)L
W
fZ
(section) (lot number) (grave number)
Name of Sexton or Person i7Cha of Premisesz (pleaseprint)
ZWSignature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013922
Receipt
Human remains of - delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#