Wilson, Barbara NEW YORK STATE DEPARTMENT OF HEALTH 2 / 5
Vital Records Section tBurial - Transit Permit
Name First Middle Last Sex
Barbara Ann Wilson Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/18/2012 65 War or Dates
' Place of Death Hospital, Institution or
WWy City, Town or Village GLENS FALLS Street Address GLENS FALLS HOSPITAL
+ Manner of Death ni Natural Cause Accident Homicide 0 Suicide Undetermined ❑ Pending
WI—I Circumstances Investigation
WMedical Certifier Name Title
c,...e0
A..ress C
ti ,/ CertificaterVillage
Filede , / f� � /�� District Number ' RegisZ Z er
/� Town or Villa e ( �/ l
DirBurial Date = -. 'r Cremato
❑Entombment _G,-Gv
05/25/2012 / ,. /L,� ‘e7 rit
Address raj /j
El Cremation (xr/� &d ,�/ ['� ---00-0.7�,e u./ ... „--, , kric:3 ?
Removal Date Place Removed
z▪ and/or and/or Held ri
Hold Address
Date Point of
• ❑Transportation Shipment
0 by Common Destination
CI Carrier
Disinterment Date Cemetery Address
EiReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2' Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued bo I Registrar of Vital Statistics LA) }
(signature)
., District Number 5 b Q r Place 6 (..S2Az•-S -FA \ ! S W 9
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 511 r 111_ Place of Dispositiontt�
w2 P po � Fr...Oro., Cr�r��or�� -
2 (address)
CO
Ce (section) /f . (lot number) r (grave number)
0
Ng Name of Sexton or Per on in Char of Premises L/hI - e4.414"
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Signature Title Cat4PK0A,
(over)
DOH-1555 (02/2004)