Robarge, BarbaraL31
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial -Transit Permit
Name First Middle Last
Sex
Barbara A Robar a
Female
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/25/2019
77 Years
War or Dates
ZPlace
of Death
Hospital, Institution or
City, Town or Village Alban
Street Address St Peters Hospital Community Hospice
Manner of Death RKINatural Cause Accident Homicide Suicide Undetermined Pending
`p
V
Circumstances Investigation
0
Medical Certifier Name Title
Constance Stalker NP
Address
315 S Manning Blvd, Albany, New York 12208
Death Certificate Filed
District Number
Register Number
City, Town or Village Albany
0101
2062
Burial
Date
Cemetery, Crematory or Facility Name
09/27/2019
Pineview Crematory
Entombment
aCremation
Address
Queensbury Town, New York
❑ Donation
Z
Date
Place Removed
Q
❑ Removal
and/or
and/or Held
F-
U5
Hold
Address
O
IL
N
❑ Transportation
Date
Point of
G
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
f...
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 09/26/2019 Registrar of Vital Statistics Danielle S Gillespie (Electronically Signed)
(signature)
District Number 0101 Place Albany, 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 III bi Place of Disposition
/address)
W
N
IX
(section) A(lot number) r (grave number)
J
SName
of Sexton or Person in Charge of Premises (easeprint)
Z
W
11
Signature Title �n+r7U2
DOH-1555 (07/18) p t of 2
Public Health Law Sec. 4145(2b) 012558
Receipt
Human remains of delivered on -1 201
Pine View Cemetery F Relligs-enting the funeral home named on burial permit
Official Funeral Directors Reg. or License#