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Curley, Barbara 6 t 11137 )RK STATE DEPARTMENT OF HEALTH;cords Section Burial - Transit Permit ,me First Middle Last Sex Barbara Jane Curley Female late of Death Age If Veteran of U.S. Armed Forces, February 26, 2015 85 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital a Manner of Death X Natural Cause Accident n Homicide Suicide n Undetermined Pending Circumstances Investigation IAMedical Certifier Name Title Dean Reali,MD Address Glens Falls,NY Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY 5601 l ©q ❑Burial Date Cemetery or Crematory March 27, 2015 Pine View Crematorium ❑Entombment Address CI Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed ZZ �Removal and/or Held and/or Address I= Hold Cl) 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above gAddress W. a Permission is hereby granted/ to dispose of the human remains described above as indicated. Date Issued Z 1 2. 7` l5 Registrar of Vital Statistics k..AdC,U - p., (signet re) District Number 5601 Place Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3lli'1S- Place of Disposition gIL C br.,, 2 (address) W U) 0 (section) /�/ (lot numper) (grave number) QName of Sexton or Person in Charge of Premises tit, Jt,. 1' W (please print) Signature �1 Title fits*PtI ', (over) DOH-1555(02/2004)