Loading...
Barnes, Amanda NEW YORK STATE DEPARTMENT OF HEALTH ` 1 A Zg Vital Records Section Burial - Transit Permit i Name First Middle Last Sex ma Amanda W. Barnes Female ;:,'a Date of Death Age If Veteran of U.S. Armed Forces, March 29,2016 70 War or Dates : Place of Death Hospital, Institution or gCity, Town or Village Thurman Street Address 68 Frost St. O Manner of Death X Natural Cause n Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Suzanne Bergin MD :•:y Address x" a 3767 Main Street,Warrensburg,NY 12885 ::v.e Death Certificate Filed District Number Register Number °: City, Town or Village Thurman 5659 n 1 ❑Burial Date Cemetery or Crematory ❑Entombment March 31,2016 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold Cl) O Date Point of N n Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address „:: Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 J=H:; Address 3809 Main Street,Warrensburg,NY 12885 .x., Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ' ' ..: ; Permission is hereby granted to dispose`ofthe human re ins described above as in icated. Date Issued :2)la I I �Le Registrar of Vital Statistics Jwu,e , /signature 161—‘). =:=r3 ` . District Number ax5cl Place T/O Thurman,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition -11lj(ftp Place of Disposition -R,( Up-./ av,atom 2 (address) W Cl) re (section) (lot numb ) (grave number) pName of Sexton or Person in Charge of Premises /4(`'Ip(, Z (please print) W Signature Title1(M41.7t (over) DOH-1555 (02/2004)