Williams, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
.. Name First Middle Last Sex
Barbara K. Williams Female
Date of Death Age If Veteran of U.S. Armed Forces,
• October 9, 2011 90 War or Dates
'� Place of Death Hospital, Institution or
: City, Town or Village Glens Falls Street Address Glens Falls Hospital
LIS
ci, Manner of Death n Natural Cause Accident n Homicide I I Suicide Undetermined Pending
til Circumstances Investigation
Medical Certifier Name Title
P' Danushen Sooriabalan,MD
Address
lGlens Falls,NY 12801
Vapi Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls,NY 5601 W L4 Li
El Burial Date Cemetery or Crematory
October 11, 2011 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
I:: Hold
N
0 Date Point of
cck n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan-Minahan& Potter 01646
Address
407 Bay Road, Queensbury, NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
g" Address
re
.• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued to )/i 11 f Registrar of Vital Statistics LA)c �13
(signature~
• District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z L04.-S-tdtz.,
W Date of Disposition to i Ill 1 Place of Disposition �Nt �J
2 (address)
W
Cl)
OC (section) (lot number)C (grave number)
pp• Name of Sexton or Perso 'n Charge of Pr ises A h' J r P rid�'f
Z please print)
W
Signature Title CV li IV RD
(over)
DOH-1555(02/2004)