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Barber, Elizabeth NEW YORK STATE DEPARTMENT OF HEALT , % It ZC Vital Records Section Burial - Transit Permit Name First addle Last Sex Elizabeth Louise Barber Female ' 1 Date of Death Age If Veteran of U.S. Armed Forces, April 26, 2011 71 War or Dates €_— Place of Death Hospital, Institution or ;„ City, Town or Village Argyle Street Address 164 West Road Manner of Death X❑ i, Natural Cause ElAccident E Homicide n Suicide ❑ Undetermined ❑ Pending Circumstances Investigation ,, Medical Certifier Name Title Matthew C. Pender, Address 2 1 Myrtle Ave. Cambridge, NY 12816 :- Death Certificate Filed District Number Register Number City, Town or Village _95-6 02 0 Burial Date Cemetery or Crematory ti April 27, 2011 Pine View 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed and/or Held and/or Address Hold Date Point of , 0 Transportation Shipment J by Common Destination Carrier ❑ Disinterment Date Cemetery Address ILi Reinterment Date Cemetery Address • ' Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01096 -t-1 Address - 123 Main St., Argyle NY 12809 ' Name of Funeral Firm Making Disposition or to Whom ir Remains are Shipped, If Other than Above Address 1 ` Permission is hereby granted to dispose of the human r ins described abo e as indicated. y Date Issued I MI,/ /( Registrar of Vital Statistics (signature) District Numbers 75 jj —o Place ---rb 7t_ 0-/ 74--Cgcli-C . l I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 04/27/2011 Place of Disposition Quaker Road Queensbury,NY 12804 -77 s (address) s (section) ` (lot num ) (grave number) Name of Sexton or Pe on in Charge Premises L «s -niLI- (please print) ° Signature Title h 14jbf-- (over) DOH-1555 (02/2004)