Warren, Barbara ` -1 SOO
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Lorraine Warren Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/09/2018 91 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause D Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
John Quaresima MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 336
❑Burial Date Cemetery or Crematory
07/10/2018 Pine View Crematory
Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
r. Carrier
Of
❑Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
On Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/09/2018 Registrar of Vital Statistics RgliertACurtis(ECectronicaffySigned)
(signature)
Fl
District Number 5601 Place Glens Falls, New York
Mi
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
pr-
Date of Disposition '/ji I ig Place of Disposition -evv.d 6t+AA.'tav
(address)
al
° (section) (lot num er) ( (grave number)
al
Name of Sexton or Person in Charge of Premises ('t L� StA»ra
Fi2 /� (please print)
Signature II -- Title 92
(over)
DOH-1555(02/2004)