Whalen, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Jean Whalen Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/07/2018 78 Years War or Dates
aPlace of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
W Manner of Death X❑Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
ut Medical Certifier Name Title
0 Rick Teetz MD
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 323
El Burial Date Cemetery or Crematory
06/18/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
ft Hold
Date Point of
11,
❑Transportation Shipment
# by Common Destination
Carrier
Disinterment Date Cemetery Address
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
.: Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
k. Remains are Shipped, If Other than Above
• Address
IZ
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/11/2018 Registrar of Vital Statistics gofin P Franck(ECectronicallySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 6 1 i1 I is Place of Disposition PM4J [woe..,.
2 (address)
III
to
ix (section) (I t number) (grave number)
O• Name of Sexton or Person in Charge of remises tirl l? --)A-- rt
Z (please rint)
W. Signature 6 Title ""i iZVL
(over)
DOH-1555(02/2004)