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Barrows, Barbara NEW YORK STATE DEPARTMENT OF HEALTH ' • • % k 5 L Vital Records Section Burial - Transit Permit Name First Middle Last Sex Barbara Louise Barrows Female Date of Death Age If Veteran of U.S. Armed Forces, January 30, 2011 74 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death❑ ❑ I I ❑ n Undetermined ❑ Pending X Natural Cause Accident Homicide Suicide Circumstances Investigation Medical Certifier Name Title John Stoutenburg, M.D. Dr. 4 Address 102 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number �-7 D� Regis/lumber umber City, Town or Village ,5(0 ' 7 4. ❑Burial Date Cemetery or Crematory February 1, 2011 Pine View Crematorium ❑Entombment Address ,, ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Pine View Crematorium Date Point of ❑Transportation Shipment d by Common Destination Carrier ❑ Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom : Remains are Shipped, If Other than Above Address Permission is h reb granted to dispose of the human re ins described above as indic ted. to Date Issued n l?I /7 Registrar of Vital Statistics .,' C.:z-� gnat e District Number ( �� /Place �i)� I certify that the remains of the decedent identi d above were disposed of in accordance with is permit on: Date of Disposition Fee) i le?ii Place of Disposition -Pt 0t 614,, sr> (address) (section) (lot number) (grave number) Name of Sexton or P rson in Charge o remises �f+Jfr r ,S 4 4 1 /� (please print) Signature , ' Title MI mi-TToit-- (over) DOH-1555 (02/2004)