Stetson, Barbara '7 ' fr S10
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 1' Burial - Transit Permit
Name First Middle Last Sex
Barbara June Stetson Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 21,2011 83 . . War or Dates
1, Place of Death Hospital, Institutior)tirondack Tri-County Health Care
.Z City, Town or Village Johnsburg Street Address Center
,0 Manner of Death IXI Natural Cause Accident I I Homicide Suicide Undetermined Pending
ALL Circumstances Investigation
Al
w Medical Certifier Name Title
, Tom Warrington PA
Address
North Creek Health Center,North Creek,NY 12853
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655
❑Burial Date Cemetery or Crematory
Entombment November 22,2011 Pine View Crematory
Address
®Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
I
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
t. ' Remains are Shipped, If Other than Above
Address
ft
EL,; Permission is hereby granted to dispose of the human rem ins esci3e.411Pve as indicated.
a3I
Date Issued // f 20V Registrar of Vital Statistics G� C-��^ '
1 (signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition NpJ ZS'` Z(,i,1 Place of Disposition 2r, VWCL Crv*4[Or1V-^
(address)
W
CO
CL (section) d . (lot number)c (grave number)
pName of Sexton or Person in Charge of Premises ci5� I^i.,r• Q„4W
'Z please print)
Signature /At /�"` Title OE Abt 'd
(over)
DOH-1555 (02/2004)