Barber, Linda ,- li (HZ-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linda A. Barber Female
Date of Death = Age If Veteran of US.Armed Forces,
03/19/2014 t 65 vrs. War or Dates No
Place of Death Town of Hosplal_Insfitution or
City,TownorL ge Elizabethtown , StreetAddress Horace Nye Home
Au
a Manner of Death 0 Natural Cause t 0 Homicide QSoicide EIUndetermined El Pending
Circumstances Investigation
le Medical Certifier Name Title
Rob Demuro M.D.
Address
Horace Nye Home, 81 Park St. , Ticonderoga, NY 12883
Death Certificate Filed Town of District Number / ) Register Number
City,Town or Village Elizabethtown I . "--
['Burial Date Cemetery or Crematory
;" ]Entombment 03/21 /201 4 Pine View Crematory
Address
a.BJCremation Queensbury, NY
Date Place Removed
* Removal and/or Held
and/or Address
0,9 Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
.:: Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
11 Algonkin St. , Ticonderoga, NY 12883
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
f .
W
C Permission is hereby granted to dispose of the human rahnaiop des ribed aboyp as indicated.
Date Issued 3/21 /2 01 4 Registrar of Vital Statistics �'(. �-
(signature)
District Number 1`j Place 7fr?a` k. ,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k p
Iirt Date of Disposition 3)a4 jI Place of Disposition �i'^t `' Ct4p tttiv--
2 (address)
fa
f (section) (lot number (grave number)
Name of Sexton or Person' Charg Premises . rN torn}
Z (phase print)
k Signature of Title (bxrrfi
(over)
DOH-1555 (02/2004)