Barker, Walter NEW YORK STATE DEPARTMENT OF HEALTHIt' \10 I(t
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Walter L. Barker ! Male
Date of Death Age If Veteran of U.S. Armed Forces,
February 27, 2012 1 77 War or Dates
I,, Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls 1 Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
Ili Medical Certifier Name Title
CI Gerald Abess,MD
Address
Glens Falls,NY
Death Certificate Filed District Number i Register Number
City, Town or Village Glens Falls,NY 5601 9Z-
111 Burial Date Cemetery or Crematory
February 29, 2012 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
0and/or Address
- Hold
Cl)
O Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2 Address
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WQ.
- —
Permission is hereby ranted to dispose of the human remains describe abov a 'ndi
Date Issued D 1 2O/2--- Registrar of Vital Statistics
(sig ature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 6.41 I� tbt( Place of Disposition Rfti(1L �1orn..-.
(address)
W
U)
d' (section) (lot number) (grave number)
a• Name of Sexton or Person in Char e of Premises d P*pit— Snriti-
Z (please print)
uJ Signature Title Cefinabgt
(over)
DOH-1555(02/2004)