Sebeck, Barbara NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex Female
Barbara L. Sebeck
Date of Death
Age i If Veteran of U.S.Armed Forces, ._.
3/20/2013 86 War or Dates No
ti
44 Place of Death Hospital, Institution or
Q . Town li i Lake Luzerne i Street Address 26 Zermatt Dr.
Manner of Death(J Natural Cause �Accident Homicide �Suicide Undetermined 0 Pending y
Circumstances Investigation
`: Medical Certifier Name Title
Howard E. Silverberg M.D.
Address
318 Broadway, Fort Edward,NY 3
Death Certificate Filed i District Number Register Number,Town)4204110PC Lake Luzerne 5656 i
Date Cemetery or Crematory
0 Burial 3/25/2013 Pine View Crematory
Address
Cremation i Queensbury,NY
Date Place Removed
Z❑Removal and/or Held
and/or W._u
�„ Address
-� Hold
tf}
o ' Date Point of
0 Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment i Date ; Cemetery Address
< Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home, Inc. 00211
'' Address
24 Church St., Lake Luzerne,NY 12846
` Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped. If Other than Above
Address
W
to Permission is hereb granted to dispose of the human r, sins de$c I d bove as indi ted.
Date Issued 3 Registrar of Vital Statistic 0 C
(signature)
District Number „:5(0510 Place h C- - Z A.../K-P---
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 1-2b-3 Place of Disposition .cj w w4dfl *.
2 (address)
W
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charg of Premises
41-,311.9-- Q nrF�-
Z (please print)
44 Signature 4, A, . Title Clbe r _
DOH-1555 (10/89) p. 1 of 2 VS-61