Barnaby Sr, Eugene NEW YORK STATE DEPARTMENT OF HEALTH \ � I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Eugene Francis Barnaby, Sr, j Male
Date of Death ' Age 1 If Veteran of U.S. Armed Forces,
09/07/2016 68 yrs. War or Dates Vietnam War
iii4i Place of Death Town of Hospital, Institution or
City, Town or Village Hague Street Address 2 Whippoorwill Lane
La Manner of Death C Natural Cause —_ Accident I I Homicide El Suicide ❑Undetermined ❑Pending
1.4jCircumstances Investigation
rj Medical Certifier Name Title
ti
A Pl Gillani M.D.
Addressffii P
102 Park Street, Pruyn Pavilion, Glens Falls, NY 12801
it Death Certificate Filed Town of District Number Register Number
City, Town or Village Nagi,P 5651
Date Cemetery or Crematory
❑Burial 09/09/2016 Pine View Crematory
Address
Cremation Oueensbury, New York
Date Place Removed
Z C Removal ; and/or Held
k and/or Address
rib
Q • Date ' Point of
n Transportation I Shipment
E5 by Common Destination
Carrier
Disinterment❑ Date I Cemetery Address
<' ❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
tg Address
iiiiii 11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
014 Address
g.
AL
Permission is hereby granted to dispose of the hum remains described ove a indicated.
Date Issued 9/9/201 6 Registrar of Vital Statistics` u ; n I) ,�
_ s ature)
Place Town of Hague
District Number���� q e
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 9j1z114 Place of Disposition Tlnt( b.) 4 npCor1✓
2 (address)
LJJ
CC (section) //lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises .1(�1�.. 041-
z (please print)
W Signature t Title ar-MItve
DOH-1555 (10/89) p. 1 of 2 VS-61