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Barber, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mary Anne Barber Female Date of Death Age If Veteran of U.S. Armed Forces, `'. 02/13/2018 56 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Ci Manner of Death©Natural Cause ❑Accident ❑Homicide El Suicide ElUndetermined ri Pending ' Circumstances Investigation frEl Medical Certifier Name Title Joseph Hayes MD $ Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City, Town or Village Saratoga Springs 4501 103 ❑Burial Date Cemetery or Crematory 02/16/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury, New York kl Date Place Removed Removal and/or Held and/or Address Hold Date Point of tiz Li Transportation Shipment • by Common Destination 0,4 Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Wilcox&Regan 01821 Address 11 Algonkin St,Ticonderoga,New York 12883 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address H Pi • Permission is hereby granted to dispose of the human remains described above as indicated. Frj Date Issued 02/15/2018 Registrar of Vital Statistics John P Franck(ECectronicaftySigned) (signature) District Number 4501 Place Saratoga Springs, New York - I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 114.1 Date of Disposition 1/1©l13 Place of Disposition i. .,.,# i (address) (section) pot nu (grave number) • Name of Sexton or Person in Charge of emises /Li.L!ease p nt) Signature Title 1f trr (over) DOH-1555 (02/2004)