Duell, Barbara NEW YORK STATE DEPARTMENT OF HEAL1H - a 4 L(07
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Ann Duell Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/o�a/2012 84 years War or Dates
}- Place eat Hospital, Institution or
ii City, To V� Street Address
X X Clcns F^ Glens IIS i{o ital
Manner of"Deat iii Natural Cause Accident Homicide Suicide unde�rmmed Pending
Circumstances Investigation
w Medical Certifier Name Title
Addressed A. Siddiqui M D
100 Park Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Tov JilX Glens Falls 5601 369
❑Burial dilate Cemetery or Crematory
❑Entombment Addres O8/07/2012 Pine View Crematorium
❑ emation QuePnsbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
1=' Hold
C
0 Date Point of
❑Transportation Shipment
C by Common Destination
Carrier
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 I afayette Street Oueensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
l
P.7 Permission is hereby granted to dispose of the human remains described above as indicated.
t
Date Issued 08/06/2012 Registrar of Vital Statistics V,j L,rr.SZ l/`�...A/\-
(signat )
District Number 5601 Place dens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iLi Date of Disposition 4-S-1 Z Place of Disposition Rol thiv (�riPilor,u._
(address)
U
C (section) (lot number (grave number)
CI Name of Sexton or Person in Charge of Premises /(ki ,- [f
2 p (please print)
114
Signature , t _go-
::--- Title ctavi1ttIo(L
(over)
DOH-1555 (02/2004)