Perry, Barbara NEW YORK STATE DEPARTMENT OF HEALTH ( x
Vital Records Section Burial - Transit Permit
i
Name First Middle Last Sex
Barbara Perry 1 Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 25, 2011 1 84 War or Dates
f. Place of Death Hospital, Institution or
Z: City, Town or Village Lake George [ Street Address 4 Chestnut Street
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
; p Medical Certifier Name Title
P.' Paul Bachmann,Coroner
Address
Warrensburg,NY
Death Certificate Filed j District Number - O ; Register Number 3
City, Town or Village Lake George,NY j
❑Burial Date Cemetery or Crematory
September 29,2011 Pine View Crematory
❑Entombment Address
1:Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
Hold
0 Date Point of
N ( Transportation j 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
1 Remains are Shipped, If Other than Above
Y2 Address
re
W -
Permission is hereby granted to dispose of the human rem ins described above s indicated.
Date Issued 9`a /
7 6/) Registrar of Vital Statistics j(�,�p y0 .�/Le./X.
f (signature)
District Number 56 26 Place Lake George,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 41 130It\ Place of Disposition P.,tUli� `tt.1 0JIN.."
2 (address)
W
N
O (section) (lrti.4c..r-
Z (lot number) ( (grave number)
p Name of Sexton or Person in Charge of Pr ises (please print)
W C Title 'Q-ON1
Signature ( NVl U4-
(over)
DOH-1555(02/2004)