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Hirsch, Barbara --4 ` / NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ` : Name First Middle Last Sex Barbara B. Hirsch Female Date of Death Age If Veteran of U.S. Armed Forces, July 31,2011 _ 73 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls _ Street Address Glens Falls Hospital cii Manner of DeathLi_ki Natural Cause 0 Accident. n Homicide Suicide n Undetermined Pending Circumstances Investigation Medical Certifier Name Title P Suzanne Blood,MD Address Queensbury,NY Death Certificate Filed —I District Number Register Number City, Town or Village Glens Falls,NY € 5601 %3 V2— ❑Burial Date Cemetery or Crematory Eft 4ugust 3,2011 1 Pine View Crematory Address ®Cremation Quaker Road, Queensbury,NY 12801 Date Place Removed ZZ ri Removal and/or Held and/or Address F Hold tn O Date Point of W n Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number ':: Name of Funeral Home Regan& Denny Funeral Home 01443 Address . 53 Quaker Road,Queensbury,NY 12804 _ Name of Funeral Firm Making Disposition or to Whom IN:, Remains are Shipped, If Other than Above Address - Permission is hereby granted to dispose of the human iemains descc iibed ab e as ' i ated. Date Issued Qd©3 / Registrar of Vital Statistics � Pl� / (signature) District Number 5601 Place Glens Falls,NY I-- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition I--5-1( Place of Disposition .PNU il--1 C•n.cTJ ‘rl�... W (address) N cc (section) ( mber) (grave number) pName of Sexton or Person in Charge of Premises a1(,) .. '.-4f `11 Z i (please print) Signature Title Cp.MI AT°0... (over) DOH-1555(02/2004)