Hill, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara J Hill Female
Date of Death Age n If Veteran of U.S.Armed Forces,
I. July t, 2016 I g War or Dates
Z Place of Death Town of Whitehall Hospital, Institution or 971 CountyRoute 10
G Manner of Death (�Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined ❑ Pending
W �/ Circumstances Investigation
0 Medical Certifier Name Title
W Abigail Wikoff FNP
Q Address
65 Poultney Street Whitehall New York 12887
Death Certificate Filed District Number 6.71.406, Register Number
CityLo r Village v\ V1 t- a)
❑Burial Date July 15 2016 Cemetery or Crematory
Pine View Crematory
❑Entombment Address
®Cremation Town of Queensbury
Date Place Removed
0 ❑Removal and/or Held
and/or Address
F. Hold
J Date Point of
0 ❑Transportation Shipment
d by Common Destination
0Carrier
- Date Cemetery Address
a ❑ Disinterment
El
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
i- Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
ft
W Address
0.
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I- 1L.1-21)i, Registrar of Vital Statistics 42 0
(signature)
District Number `(p� Place .A) k �( ,1 t 2.1�) ( j)r`�
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z •�
W Date of Disposition ?p ro Place of Disposition Pr)?Q il` e ) cli-imic y
W (address)
In
section
� (section) ll (lot umber) (grave number)
ZName of Sexton or Pers in Char a of Premises J u„)Ian Mitl-c.4ie
W (please print)
Signature Title e-12-,�1
(over)
DOH-1555 (02/2004)