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Barrett, Michael NEW YORK STATE DEPARTMENT OF HEALTH k S Z Vital Records Section Burial - Transit Permit 7 Name First Middle Last Sex Michael Lee Barrett Female Date of Death Age If Veteran of U.S. Armed Forces, July 15, 2018 75 War or Dates x Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 73 Orchard Street CI Manner of Death X Natural Cause Accident Homicide 0 Suicide El Undetermined ri Pending 111, Circumstances Investigation II Medical Certifier Name Title CI Gerald F Abess MD, Address 3 Irongate Ctr. Glens Falls, NY 12801 7,41 ° Death Certificate Filed District Nu%bep Register .Vr City, Town or Village 77((�� S ❑Burial Date Cemetery or Crematory I, July 17, 2018 Pine View Crematorium ❑Entombment Address gt ©Cremation Quaker Road Queensbury,NY 12804 _, Date Place Removed 2_ ❑ Removal and/or Held and/or Address C. Hold 09 Date Point of ❑Transportation Shipment .0. by Common Destination Carrier ❑ Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address y N Permit Issued to • Registration Number O s Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Y Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom t Remains are Shipped, If Other than Above Address CC tti.. Permission is he eby granted to dispose of the hum re cribed a ' ve indi ated. Date Issued ( Registrar of Vital Statisti s ZJj�-„�, , ,' fi-e (sign tun�e)t District Number r5 Place F�� �/ certify that the remains of the decedent identified above were disposed of in accordance w' this permit on: W Date of Disposition 07/17/2018 Place of Disposition Quaker Road Queensbury,NY 1 804 [l`. (address) it (section) /i (lot numbe (grave number) to Name of Sexton or Person in Charge of Premises L �risipL �K' cz.,,. 4 (please print) Signature Title fr /M14t114 , (over) DOH-1555 (02/2004)