Harpp, Barbara " .-�tAi;
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
:d T Barbara Jean Harpp Female
Date of Death Age ' If Veteran of U.S. Armed Forces,
March 9, 2017 71 War or Dates
- of Death Hospital, Institution or
It City, own or Village Glens Falls Street Address Glens Falls Hospital
M-"ner of Death rim
E.J Natural Cause ❑14 Accident ❑ Homicide E Suicide ❑ Undetermined El❑ Pending
Circumstances Investigation
81 Medical Certifier Name Title
a Noelle Stevens, M.D. Dr.
Address
100 Broad St. Glens Falls, NY 12801
`a i h Certificate Filed - l District Number Register N mber
City Town or Villager[ e -a_(,l5 5601 /S
urial Date Cemetery or Crematory
March 13, 2017 Pine View Crematorium
rygd 0 Entombment
Address
. ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑
Removal and/or Held
and/or Address
Hold
�V,
Date Point of
❑Transportation Shipment
fil by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
g
❑ Reinterment
Date Cemetery Address
gg-
-g Permit Issued to Registration Number
,11.4 Name of Funeral Home Carleton Funeral Home, Inc. 00281
t Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
3 g Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
:- Address
ir
W.
Permission is hereby ranted to dispose of the human remains desc �d, o a ated.
vti
Date Issued 4�3A3 1.f}/) Registrar of Vital Statistics
�� / ��
(signature
District Number 5601 Place �7, 7/,�, /
f I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 03/13/2017 Place of Disposition Quaker Road Queensbury,NY 12804
2 (address)
w
0?'
(section) /, (lot number) (' (grave number)
0 Name of Sexton or Person in Charge of Pre ises G 4r;c{ vt Jt it IP-
A (pl se print)
r Signature �� Title [RE Maw,
(over)
DOH-1555 (02/2004)