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Hall, Barbara I `7 CO NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex ` Barbara Ann Hall Female f Date of Death Age If Veteran of U.S. Armed Forces, 4 February 19 2017 71 War or Dates s-` Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 11 Reservoir Drive Manner of Death n Natural Cause n Accident n Homicide Suicide n Undetermined J Pending • Circumstances Investigation Medical Certifier Aame Title C-r1 Address 10 Death Certificate Filed ,� 4' District Number Register Number City, Town or Village --"'7 Queensbury, NY 5657 c ❑Burial Date Cemetery or Crematory Entombment February 21, 2017 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed O2 l Removal and/or Held and/or Address Hold U) 0 Date Point of ys n Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number T. Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Y.. Address oxo.' lift 53 Quaker Road, Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom `X Remains are Ship ped, If Other than Above Address Permission is hereby granted to dispose of the human rem ins described abov as indicated. 1°� 0Date Issued Registrar of Vital Statistics ��. i (signature) i District Numbt jt �fl Place ., o �-).‘---, Q { I certify that the remains of the decedent identified above were disposed of in accordan wit this permit on: W Date of Disposition "2 2/ r7 Place of Disposition /�Yi(> t) ti .1 C i2..,yvta lz:ty W / / (address) / co CC (section) ` t number) (grave number) z. Name of Sexton r,Pers n in Charge of Premises J t )1cam vi 7 t }may? e-i. h I r (please print) I Signature j' / w Title C-f�) 1e 7C1 e t k/- (over) DOH-1555(02/2004)