Allen, Barbara NEW YORK STATE DEPARTMENT OF HEALTH Y'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Florence Allen Female
p,,• :! Date of Death Age If Veteran of U.S. Armed Forces,
February 14, 2011 72 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
alf Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Wr Circumstances Investigation
a Medical Certifier Name Title
Robert W. Sponzo, MD
Address
It Glens Falls Hospital, Glens Falls, NY
Death Certificate Filed District Number Regjtecr mber
n City, T5 Glens Falls 5601 JJ
El Burial Date Cemetery or Crematory
February 18, 2011 Pine View Crematorium
❑Entombment Address
; ',®Cremation Quaker Road Queensbury,NY 12804
' Date Place Removed
Removal and/or Held
:may and/or Address
;,r..„
w Hold
.1,
Date Point of
nTransportation Shipment
. by Common Destination
C i,, Carrier
Disinterment Date Cemetery Address
a
Reinterment Date Cemetery Address
z 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
l Remains are Shipped, If Other than Above
il Address
14 Permission is hereby granted to dispose of the human remains described above as indicated.
h Date Issued 2/i 7/r/ Registrar of Vital Statistics W CA.k. iiVJi-^
� ,_ (signature)
,w▪w District Number 5601 Place City of Glens Falls, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition �- 2 f - Place of Disposition Pvv0i1N-) Cl"ct ot iv,�
(address)
'W:'
VI
(section) (lot numbe (grave number)
t Name of Sexton or Per on in Charge o remises ( rtcsli0 ✓ t MH
.z' j (please print)
Signature k Title CCgAbAT..
(over)
DOH-1555 (02/2004)