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Kennedy, Barbara NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial _ Transit Permit Name First Middle Last Sex Barbara J.Kennedy Female Date of Death Age If Veteran of U.S.Armed Forces, 06/30/2017 71 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Sean Bain MD Address 100 Park St.,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Granville Village 5725 15 El Burial Date Cemetery or Crematory 07/05/2017 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier ID 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 07/05/2017 Registrar of Vital Statistics 4tjdiardApben4 Ekctmnicaffy Signed (signature) District Number 5725 Place Granville Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1- )-(1 Place of Disposition 11�V rrry+a1or (address) (section) /(lot number) (grave number) Name of Sexton or Person in Charg of Premises /"hilt (ar ^1Ctfi (pl print) Signature Title fltEM fife (over) DOH-1555 (02/2004)