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DeMuro, Barbara NEW YORK STATE DEPARTMENT OF HEALTH a \ t,G Vital Records Section Burial - Transit Permit Name First Middle Last Sex Barbara DeMuro Female Date of Death Age If Veteran of U.S.Armed Forces, I. November 26, 2012 58 War or Dates NO Z Place of Death Hospital, Institution or W City,Town,or Village Huletts Landing Street Address Residence 0 Manner of Death ®Natural Cause ❑ Accident ❑ Homicide Suicide E Undetermined E Pending W Circumstances Investigation U Medical Certifier Name Title W Max Crossman MD 0 Address 64 Poultney Street Whitehall New York 12887 Death Certificate Filed District Number Register Number City,Town or Village Huletts Landing 5 752- OS' ❑Burial Date Nov. 29, 2012 Cemetery or Crematory Pine View Crematorium ❑Entombment Address ©cremation Quaker Road Queensbury New York Date Place Removed 0 ❑Removal and/or Held and/or Address I" Hold 0 Date Point of 0 ❑Transportation Shipment d by Common Destination Carrier 16 Date Cemetery Address ❑Disinterment LI ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 F Name of Funeral Firm Making Disposition or to Whom tY Remains are Shipped, If Other than Above W Address a Permission is hereby granted to dispose of the human remaiin�sdescri_/bed above as indicated. Date Issued ///SS)//� /�Registrar of Vital Statistics e �t.1.i 4 Wt rip--,' (signature) District Number 57S Place Huletts Landing,New York H I certify that the remains of the decedent identified above were disposed o//f in accordan�ceewith this permit on: W Date of Disposition /J-. o 2 AV- Place of Disposition s? V� wi t 4)40V 2 (address) to t (section) - Opt nu er) (grave number) 2 Name of Sexton or ers in a of Premises 17! of c,�//tyld W / (please print) Signature 7S Title 0 i7/1-46rL- / 5, (over) DOH-1555 (02/2004)