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Barlow, Michele 1 4R.3 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex II Michele Ann Barlow Female , Date of Death Age If Veteran of U.S. Armed Forces, 02/11/2018 70 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide ❑Suicide nUndetermined n Pending 37 Circumstances Investigation Medical Certifier Name Title John Quaresima MD ,,I Address 100 Park St,Glens Falls,New York 12801 - Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 80 ['Burial Date Cemetery or Crematory 02/20/2018 Pine View Crematorium ['Entombment Address A ®Cremation Queensbury, New York Date Place Removed �Removal and/or Held and/or Address Hold Date Point of -e Q Transportation Shipment f5 by Common Destination Carrier 0 Disinterment Date Cemetery Address u Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address Y 9 Pine St,Chestertown,New York 12817 k 'fit 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 02/13/2018 Registrar of Vital Statistics qp6enA Curtis(Electronically Signed) (signature) District Number Place 5601 Glens Falls, New York „, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1110Itg Place of Disposition &i,/ �,�, c 10- -, (address) (section) Lot number) (grave number) Name of Sexton or Person in Charge of P mises (tioe5.A-z*1 (pi ►►m) , Signature Title iholiing— itl (over) DOH-1555 (02/2004)