Barber, Jennifer A. tt
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
1(713
Bureau of Vital Records
Name First Middle Last Sex
Jennifer A.Barber Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/02/2020 38 Years War or Dates
F. Place of Death Hospital,Institution or
Z City,Town or Village South Glens Falls Village Street Address 129 Saratoga Avenue,South Glens Falls Village,New York 12803
`p Manner of Death ❑Natural Cause Accident ElHomicide Suicide ❑Undetermined ❑X Pending
✓ Circumstances Investigation
Q Medical Certifier Name Title
Susan Hayes-Masa Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village South Glens Falls Village 4524 13
▪Burial Date Cemetery,Crematory or Facility Name
10/07/2020 Pine View Crematory
Entombment Address
X❑Cremation Queensbury Town,New York
▪Donation
ZZ Removal Date Place Removed
O Liand/or and/or Held
Hold Address
0
a• Date Point of
Cl) 1-1
Transportation
by Common Shipment
Carrier Destination
EiDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/08/2020 Registrar of Vital Statistics Shannon7e1 er(Ekctronica(Signed)
(signature)
District Number 4524 Place South Glens Falls Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ,p-/Q-ZoZQ Place of Disposition �;A)p II;ea) C if->rv1 u'4- ''t�
2 (address)
W
CC U)
(section) (lot num er) (grave number)
• Name of Sexton or Person in rge of Pr ises {�Y jND-/ .
` (please print)
I" Signature 4/ Title Wee. CI
"?J r
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) t ' ' 14. is
Receipt
Human remains of ), delivered on , 20
Pine View Cemetery Representing the funeral home named ii burial permit
Official Funeral Directors Reg.or License# �