Loading...
Merry, Barbara .' NEW YORK STATE DEPARTMENT OF HEALTH 4 Gt Vital Records Section '� Burial - Transit Permit Name First Middle Last Sex Of Barbara Anne Merry Female • Date of Death Age If Veteran of U.S.Armed Forces, taj 07/29/2018 78 Years War or Dates Place of Death Hospital, Institution or Cit T Y, own or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Manner of Death 561 Natural Cause �Accident �Homicide �Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Eileen Spinelli NP Address 319 Broadway,Fort Edward Town,New York 12828 Cot 41 Death Certificate Filed District Number Register Number City, Town or Village Fort Edward 5755 40 ❑Burial Date Cemetery or Crematory 07/31/2018 Pine View Crematory ❑Entombment Address �_®Cremation Queensbury Town, New York Date Place Removed '';. ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment , by Common Destination • Carrier 0 Disinterment Date Cemetery Address • �Reinterment Date Cemetery Address Permit Issued to Registration Number } Name of Funeral Home Maynard D Baker Funeral Home 01130 :: Address ril 11 Lafayette St,Queensbury,New York 12804 of Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Tj Address T. • Permission is hereby granted to dispose of the human remains described above as indicated. is • Date Issued 07/30/2018 Registrar of Vital Statistics Aimee Itafoney(E(ectronicaf1ySigned) 11 (signature) it ke District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4 © ,1 p Date of Disposition g it Jtg Place of Disposition etiq,,..i L r40-. F v (address) " (section) (l ucmber) (grave number) i Name of Sexton or Person in Charge of remises ht f. L S t"��t f/ (please print) Signature 21/ Q' Title (over) DOH-1555 (02/2004)