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Spencer, Barbara A. - 11I3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara A.Spencer Female Date of Death Age If Veteran of U.S.Armed Forces, 10/10/2020 86 Years War or Dates IF=. Place of Death Hospital,Institution or City,Town or Village Johnsburg Town Street Address Elderwood at North Creek Q Manner of Death ©Natural Cause ❑Accident ElHomicide u Suicide ❑Undetermined El Pending LV Circumstances Investigation LUi Medical Certifier Name Title 0 Madison Zuis NP Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 30 �, �Burial Date Cemetery,Crematory or Facility Name 10/14/2020 Pine View Crematory ❑Entombment Address u Cremation Queensbury Town,New York ❑Donation Z Date Place Removed O Removal and/or and/or Held N Hold Address 0 CL Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination ❑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 St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom f-- Remains are Shipped,If Other than Above M Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/13/2020 Registrar of Vital Statistics Xczthreen C.Lorah(ECectronica1TySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: V � W' Date of Disposition /D'Jl 'ZO Place of Disposition I �� 2 (address) W N CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre i )^^'�f1/ lease print) W Signature _ Title c of DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1.4105 Receipt Human remains of4 �s ' c. ' delivered on , 20 r I. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# .