Tourtellotte, Barbara t (4- 111 US
NEW YORK STATE DEPARTMENT OF HEAL)
Vital Records Section Burial - Transit Permit
Name First Middle. Last Sex
`` Barbara C. Tourtellotte Female
Date of Death Age If Veteran of U.S. Armed Forces,
° %': July 17, 2014 71 War or Dates
rm'°°F Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 2A 14 Culvert Street
Manner of Death I xi Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
L' Medical Certifier Name Title
E° : Paul Bachman,MD
'° Address
Z:;:: 52 Haviland Ave. Glens Falls,NY 12801
r.:.a Death Certificate Filed District Number Register Number
t +; y VillageGlens Falls,NY 5601 `
.•;� City, Town or
E Burial Date Cemetery or Crematory
July 21, 2014 Pine View Crematorium
❑Entombment Address
Ill Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N _Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
_ Permit Issued to Registration Number
: ::: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
E Address
53 Quaker Road, Queensbury,NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
: Remains are Shipped, If Other than Above
Ss Address
• :: Permission is herebygranted to dispose of the human remains described above as p indicated.
Date Issued .7 / 2 / 1 i 4 Registrar of Vital Statistics ,,.A 4 Z
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed ofof i� . l�ntaccordaance with this permit on:
Z
W Date of Disposition "1-21-19 Place of Disposition p �t IOW... " r..
2 (address)
W
0
p0 (section) -(lot nupper) (grave number)
Name of Sexton or Person 'n Charge of Premises " j =.3'4.4
Z (please print)
W
Signature Title 011C
(over)
DOH-1555(02/2004)