Reyes, Barbara NEW YORK STATE DEPARTMENT OF HEALTH Z 6
Vital Records Section Burial - Transit Per it
lok
Name First Middle Last Sex
Barbara Ann Reyes Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 15,2016 73 War or Dates
Place of Death Hospital, Institution or
Z: City, Town or Village Lake Luzerne Street Address 30 Davern Drive
d� Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
:t , Circumstances Investigation
w. Medical Certifier Name Title
O James North
Address
100 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village
❑Burial Date Cemetery or Crematory
June 16,2016 ,Pine View Crematory
III Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
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CL
Permission is hereby granted to dispose of the human r ' s describ above as ndicated.
,Date Issued _ —M /(,Registrar of Vital Statistics sex_ ,(//
(sign ure)
District Number67 j , Place
I certify that the remains of the decedent identified above disposed of in accordance with this permit on:
t2Z Date of Disposition ((.010frj, ?M(5 _J Place of Disposition ayt on,,,..,
(address)
tu
re (section) (171`471,-,
/ (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises Q4,
Z /fj ( ase print)
LIJ
Signature v` �j Title MIX
(over)
DOH-1555 (02/2004)