Tucker, Barbara 1
t •
NEW YORK STATE DEPARTMENT OF HEALTH .,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Jean Tucker Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/06/2017 60 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village East Greenbush Town Street Address Rosewood Rehabilitation And Nursing Center
Manner of Death RI Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Maximo Valero MD
Address
284 Troy Rd,East Greenbush Town,New York 12061
Death Certificate Filed District Number Register Number
City, Town or Village East Greenbush Town 4152 99
❑Burial Date Cemetery or Crematory
08/08/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
17 Removal and/or Held
and/or Address
Hold
Date Point of
Ei Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
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 08/08/2017 Registrar of Vital Statistics xim6er0Annecatfock 'fectronicarrySignerf
(signature)
District Number 4152 Place East Greenbush Town, New York
I certify that the remains of the decedent identified above were disposed of inaccordancecl with this permit on:
Date of Disposition g`-q-l7 Place of Disposition 'f jL, 4„,0at•0..
(address)
(section) //�lot number) (grave number)
Name of Sexton or Person in Charge of Premises I Ar4 'c �•'""`
(ple a print)
a Signature Title ! 'E/t1Iti i
(over)
DOH-1555 (02/2004)