Wheeler, Barbara NEW YORK STATE DEPARTMENT OF HEALTH e "1 # U S
Vital Records Section Burial - TransitPerm it
Name First Middle Last Sex
Barbara Anne Wheeler Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 4, 2018 66 War or Dates
tPlace of Death Hospital, Institution or
City, Town or Village Hartford Street Address 85 North Road
Manner of Death❑Natural Cause El Accident ❑ Homicide D Suicide riUndetermined El Pending
0 Circumstances Investigation
W
U Medical Certifier Name Title
Dr. Paul R Philion, Pr.
Address
Irongate family Practice Assoc Glens Falls, NY
Death Certificate Filed r�" A District NumberRegister Number
City, Town or Village —1
❑Burial Date Cemetery or Crematory
Pine Vew Crematorium
11 Entombment Address
®Cremation Queensbury,NY 12804
Date Place Removed
z ❑
Removal and/or Held
and/or Address
'p Hold
a Date Point of
p,, El Transportation Shipment
0) by Common Destination
{C Carrier
Disinterment Date Cemetery Address
0 Rei
IV
Date Cemetery Address
nterment
` Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
Address
L U
C'r Permission is he eby granted to dispose of the human rema n des bed abo --, C
as indicat
Date Issued ��'l�--) i 0 Registrar of Vital Statistics k -� N r -
District Number SI 51 Place43..4-CIA
(signatu ;I
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition $Ai-il8 Place of Disposition Queensbury,NY 12804 ?wU",. 444.4r.
to 15 �� (address)
,'
ce (section) (lot/ tuber) (grave number)
0, Name of Sexton or Person in Charge of remises t "r,414,- Se.'
z A (please pnnt)
11.1, Signature 2/ Title
(over)
DOH-1555 (02/2004)