Barber, Virginia titi9
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:f•; Name First Middle Last Sex
: :A Virginia Elinor Barber Female
r.:: Date of Death Age If Veteran of U.S. Armed Forces,
*: March 1, 2015 83 War or Dates
▪'? Place of Death Hospital, Institution or
City, Town or Village
llage Queensbury Street Address 13 Gentry Lane
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John P. Stoutenburg Dr.
r Address
rrr, Glens Falls Hosp,Glens Falls,NY 12801
eve. Death Certificate Filed District Number RegiA;er Number
▪ City, Town or Village Town of Queensbury 5657
❑Burial Date Cemetery or Crematory
March 3, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
r Name of Funeral Home Regan Denny Stafford Funeral Home 01443
r Address
53 Quaker Road, Queensbury,NY 12804
: : Name of Funeral Firm Making Disposition or to Whom
I
Remains are Shipped, If Other than Above
Address
r
f: Permission is hereby granted to dispose of the human re ai s esc i.e. -b, - • = indi -ted.
I �
Date Issued —S- Registrar of Vital Statistics ,k.LQ it
:::: signature),,,
District Number 5657 Place Town of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3)Thr Place of Disposition Attl• r „•.
2 (address)
W
U)
Ce (section) (lot number (grave number)
QName of Sexton or Person in Charge of Premises �� s'eliVTr
Z (please print)
W Signature Title &aI
(over)
DOH-1555(02/2004)