Barrett, Carol NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First
4�. Middle Last _ Sex
Carol Ann Barrett Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 20, 2018 62 War or Dates
- Place of Death Hospital, Institution or
t=_ City, Town or Village Fort Edward - Street Address 20 Hunt Ave Lot 2
ILI
Manner of Death Natural Cause n Accident ❑Homicide El Suicide ElUndetermined 111 Pending
U.., Circumstances Investigation
111 Medical Certifier Name Title
Robert Lemieux,
Address
219 Pope Hill Road Argyle, NY 12809
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edwardt ''1, "" 17(0
❑Burial Date Cemetery or Crematory
December 27, 2018 Pine View Crematory
'3 ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
zElRemoval and/or Held
t and/or Address
F Hold
Date Point of
d ❑Transportation Shipment
by Common Destination
t Carrier
Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
_`s
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
Address
82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Ira Address
th. Permission is he by ranted to dispose of the hums - .ins described above as i icated.
Registrar of Vital Statist
Date Issued / � 9 6/1riat /
.----- _ (signaturg)
District Numbers-7s-S Place / 4.-) C-j-E e fad//
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 12/27/2018 Place of Disposition Quaker Road Queensbury,NY 12804 9.1„ , 4,�,v, Grer,��Qry
(address)Lii (section) (lot number) (grave number)
0' Name of Sexton or Person in Charge of Premises J fr+-t)"
Z i (please print)
Ill Signature Title C..red>v;lor
(over)
DOH-1555 (02/2004)