Brockway, Barbara { {{{ 6 V J
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Brockway Female
i> Date of Death Age If Veteran of U.S. Armed Forces,
07 / 31 / 2015 81 War or Dates N/A
Place of Death Hospital, Institution or Washington Ctr.
City, Town or Village Argyle Street Address
III0 Manner of Death®Natural Cause Accident E Homicide Suicide �Undetermined 7 Pending
itiCircumstances Investigation
La Medical Certifier Name Title
Pamela A Casey
iiM Address
4573 State Rte 40, Argyle, NY 12809
Death Certificate Filed District Number Register Number
€> City, Town or Village Argyle 575 b 37
<=DBurial Date Cemetery or Crematory
08 / 05 / 2015 Pine View Crematory
Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
VA
Hold
Date Point of
Q Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
iei
❑Reinterment Date Cemetery Address
pii` Permit Issued to Registration Number
<' Name of Funeral Home Compassionate Funeral Care, Inc 00364
Address
> 3 402 Maple Ave., Saratoga Springs, NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Cr
l
Permission is hereby granted to dispose of the human remains� described above as indicated.
giliiii
iit Date Issued 8j'I,31/S Registrar of Vital Statistics � '`.`L�L `'n/1 (As .
(signature)
District Number S 1 S. Place Argyle , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition g/fi Place of Disposition i204;U,---t Cr fI^--
(address)
tii
44.
l (section) /� .(lot numb (grave number)
0 Name of Sexton or Person ' Charge of Premises `"� All-
lease print) .
Signature *lc .
- Title /IiC41
(over)
DOH-1555 (02/2004)