Guirard, Barbara PR
NEW YORK STATE DEPARTMENT OF HEALTHI3
Vital Records Section - Burial - Transit Permit
Name First Middle Last Sex
Barbara Ann Guirard Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 16, 2015 53 War or Dates
Place of Death Hospital, Institution or
w City, Town or Village Glens Falls Street Address 18 May Street
13 Manner of Death X❑ Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
LLI
Co Circumstances Investigation
W Medical Certifier Name Title
Paul Bachman, M.D.
Address
3767 Main Street Warrensburg, NY 12885
Death Certificate Filed District Number Register f�luber
City, Town or Village 5601 J o f
❑Burial Date Cemetery or Crematory
January 21, 2015 Pine View Crematorium
. ❑Entombment
Address
'o EICremation Quaker Road Queensbury,NY 12804_ .. - •
-
Date ce Removed
z ❑
Removal :/or Held
and/or Address
;, Hold
Date Point of
❑Transportation Shipment
by Common Destination
a; Carrier
0 Disinterment Date Cemetery Address
Date Cemetery Address
El Reinterment
Permit Issued to • Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
• Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I—, Remains are Shipped, If Other than Above
2 Address
i
1LI'_
4 Permission is hereby granted to dispose of the human remains described above astindicated.
Date Issued y/"2o J 1_5 Registrar of Vital Statistics lAj CJ,j. y-'J
(signature)
District Number 5601 Place 6 (Q^^-s ru ( 15, Ai y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ing Date of Disposition 01/21/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
w
Cr (section) A (lot number) (grave number)
p Name of Sexton or Pers n in Cha ge of Premises
(please print)
Wr 9
Si nature Title ariniiiik
(over)
DOH-1555 (02/2004)