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Edwards, Barbara 7 PI NEW YORK STATE DEPARTMENT OF HEALTH{ ' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Barbara Echa Edwards Female Date of Death Age If Veteran of U.S.Armed Forces, 10/26/2017 90 Years War or Dates i, Place of Death Hospital, Institution or . City, Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death©Natural Cause El Accident 0 Homicide 0 Suicide El❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Dean Reali DO Address it 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 553 '3❑Burial Date Cemetery or Crematory 10/30/2017 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed dRemoval and/or Held 9 and/or Address + Hold Q Date Point of tik Q Transportation Shipment G by Common Destination Carrier ❑Disinterment Date Cemetery Address ,- El Reinterment Date Cemetery Address 1 Permit Issued to Registration Number Pa Name of Funeral Home Carleton Funeral Home Inc 00281 its Address h' 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address Ill ix Permission is hereby granted to dispose of the human remains described above as indicated. €.. Date Issued 10/30/2017 Registrar of Vital Statistics cPp6ertACurtis �ECectronicallySigned' s (signature) District Number 5601 Place Glens Falls, New York lr I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W� Date of Disposition if/f /i�lace of Disposition �"►..�UsN... ctn.�w W (address) U) IX (section) lm (lot number) 5 (grave number) pName of Sexton or Person in Charge of Premises UFri,z (y\.,ase print) it Signature G>( -1�/ Title (" VVVV (over) DOH-1555 (02/2004)