Nooney, Barbara ,r ) Gig
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
,� Name First Middle Last Sex
f Barbara W. Nooney Female
11 Date of Death Age If Veteran of U.S. Armed Forces,
' August 25,2015 93 War or Dates
} Place of Death Hospital, Institution or
City, Town or Village Fort Edward,NY Street Address Fort Hudson Nursing Home
Manner of Death n Natural Cause l l Accident El Homicide i l Suicide I Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Daniel Larson,MD _
Address
. Queensbury,NY _
Death Certificate Filed District Number Regis p4'Jumber
City, Town or Village Fort Edward,NY 5755 f
❑Burial Date Cemetery or Crematory
❑Entombment August 27, 2015 Pine View Crematorium
Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
Hold
CO
0 Date Point of
Wn Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
��r
rt Permit Issued to Registration Number
' F Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
3
'ili_ Address
407 Ba Roa y d, Queensbury,NY 12804 —
Name of Funeral Firm Making Disposition or to Whom
i'{' Remains are Shipped, If Other than Above
Address
Permission is ere•, granted to dispose of the I'um-; ins descr'.e bove s indicated.
Date Issued •' ,t�4 Registrar of Vital Statistic-0 /` i' V.
,f fr /
ignature)
'W District Number 61 6S Place 1 Whit
.04
I certify that the remains of the decedent identified above we disposed of in accordance with this permit on:
Z
w Date of Disposition g f iji S Place of Disposition r ,,f,r`,,,,i
2 (address)
11)
Qre (section) (lot num r) (grave number)
Name of Sexton or Person in Charge of Premises iiof'DI.,. ,,,, fir
Z f(please print)
Signature I ,., Title nu/ril t.
(over)
DOH-1555(02/2004)
i