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Barker, Frank NEW YORK STATE DEPARTMENT OF HEALTH " 251 Vital Records Section Burial - Transit ermit Name First Middle Last Sex - Frank Arnold Barker Male Date of Death Age If Veteran of U.S.Armed Forces, = May 13, 2011 75 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause ri Accident El Homicide in Suicide n Undetermined Pending Circumstances Investigation Medical Certifier Name Title Daniel Way, Dr. Address Skibowl Road North Creek, NY 12853 Death Certificate Filed District Number ) / Register Numbef City, Town or Village t �- ifD Burial Date Cemetery or Crematory May 16, 2011 Pine View Crematory --ill Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed nRemoval and/or Held VII and/or Address - Hold Date Point of I I Transportation Shipment lit by Common Destination 14 Carrier Date Cemetery Address F I { Disinterment ,4r; L Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01096 Address 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above is Address 'F Permission is hereby granted to dispose of the human remains des d bov s in gr- Date Issued D-�/6/20// Registrar of Vital Statistics 7 //�j (signature) District Number Coo` Place �jietvo /Fly', /Uy I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1110-- Date of Disposition 05/16/2011 Place of Disposition Quaker Road Queensbury,NY 12804 (address) I (section) (lot numb') (grave number) Name of Sexton or Person in Char of Premises + 4 r,st4!aAir Ss""- (please print) Signature Title Ctiniiw.t, 14, (over) DOH-1555 (02/2004)