Lynch, Barbara NEW YORK STATE DEPARTMENT OF HEALTH 3$p
Vital Records Section Burial - Transit Permit
#j Name First Middle Last Sex
Barbara S. Lynch Female
Date of Death Age If Veteran of U.S. Armed Forces,
`; May 24,2015 85 War or Dates
• a Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address Westmount Health Care Facility
W. Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
la Circumstances Investigation
ill`
Medical Certifier Name Title
1 Roslyn Socolof
Address
?a 100 Broad St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
: City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
El Entombment May 27, 2015 Pine View Crematory
Address
Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
F_, Hold
O Date Point of
u) Transportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
=1 Permit Issued to Registration Number
` Name of Funeral Home Alexander-Baker Funeral Home 00037
= ; Address
a'1 3809 Main Street,Warrensburg, NY 12885
,1 Name of Funeral Firm Making Disposition or to Whom
i Remains are Shipped, If Other than Above
Address
la
a,
Permission is herebq,
y granted to dispose of the human emainsma described a ove as indicated.
• ' Date Issued J) � `)� Registrar of Vital Statistics }�",� fLCr__
(signature)
• District Number 5657 Place j C1 � CDL), per`
I certify that the remains of the decedent identified above were disposed of in acco dan e with this permit on:
W Date of Disposition 11 I I II7 Place of Disposition Z elp.wrot—,
2 (address)
W
V
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charg of Premises ., Si,*
Title
'LI
Z a (please print)
Signature AlEAr1c**
(over)
DOH-1555 (02/2004)