Styer, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - TransiPl a mit
Name First Middle Last Sex
Barbara Styer Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 13,2014 80 War or Dates
H Place of Death Hospital, Institution or
Z City, Town or Village North Elba Street Address AMC-Uihlein Living Center
• Manner of Death g Natural Cause Accident I I Homicide Suicide Undetermined Pending
to Circumstances Investigation
WMedical Certifier Name Title
O Deborah Marshall NP-C
Address
AMC-Uihlein,185 Old Military Rd.,Lake Placid,NY 12946
Death Certificate Filed District Number Register tuber
City, Town or Village Town of North Elba 1560
❑Burial Date Cemetery or Crematory
Entombment August 14,2014 Pine View Crematory
Address
0 Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
E Hold
v)
O Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B.Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
h Remains are Shipped, If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remai desc ed above as indicated.
Date Issued 08-13-2014 Registrar of Vital Statistics 000'Cc � dVe7
(signature)
District Number 1560 Place Town of North Elba
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 'El lTI,y Place of Disposition Uw,,, C'_'o(',
(address)
W
U)
cc (section) kt-cf14.c,—(lot number (grave number)
Op Name of Sexton or Person in Charge of Premises t00(#
Z ( lease print)
W
Signature Title CTIE Ofot
(over)
DOH-1555(02/2004)