Gilbert, Barbara S W i NEW YORK STATE DEPARTMENT OF HEALTH A 7 t N
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Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Barbara Lee Gilbert Female
" Date of Death Age If Veteran of U.S. Armed Forces,
:,,, O• ctober 13,2016 93 War or Dates
'iPlace of Death Hospital, Institution or
Ci• ty, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death Natural Cause Accident Homicide SuicideEl Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
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Death Certificate Filed ( District Number J� Regis r Number
City, Town or Village 11(1 GU&a k GJ 3
Date
❑Burial Cemetery or Crematory
October 14,2016 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z ❑Removal and/or Held
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and/or Address
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O Date Point of
N ❑Transportation 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 Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
F Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
1`�<f Permission is hereby granted to dispose of the huma remains describe abo e as indicated.
"z Date Issued l 3-4(D Registrar of Vital Statistics I
(sig ature
g District Number Place -7 n, c4..J j caw
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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isi Date of Disposition f0II7/it, Place of Disposition 'UntOlt..., lrtema7► f"."
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re (section) //// (lot number) (grave number)
pName of Sexton or Person in Charge of P emises Lh ,L1'1✓#
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(over)
DOH-1555(02/2004)