Farr, Barbara Dian ,. t ff SZ�
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Dian Farr Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/01/2020 79 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Wilton Town Street Address 553 Wilton Gansevoort Road,Wilton Town,New York 12831
p Mannerof Death FK Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
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W Medical Certifier Name Title
Lynn Keil PA
Address
1340 State Route 9,Lake George Town,New York 12845
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 16
Burial Date Cemetery,Crematory or Facility Name
05/06/2020 Pine View Crematory
Entombment Address
RI Cremation Queensbury Town,New York
❑Donation
z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
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IL Date Point of
fA ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
FJReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
p- Remains are Shipped,If Other than Above
Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/06/2020 Registrar of Vital Statistics Susan Ballwin(EkctronicatySigned)
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Place of Disposition t—hQ 12m
2 (addres)
W
N
Q (section) (lot number) (grave number)
8 Name of Sexton or Pers a of Premises J ,a, �� �`-U� 'e'
Z (please print)
W Signature Title G '� t
DOH-1555(o7/18)p 10 2
Public Health Law Sec. 4145(2b) 0 13 7 1
Receipt
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Human remains of delivered on ?" , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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