Lynch, Barbara NEW YORK STATE DEPARTMENT OF HEALTH 4. { t�
Vital Records Section Ufla� - Transit rlxll
Name First Middle Last Sex
Barbara S. Lynch Female
Date of Death Age If Veteran of U.S.Armed Forces,
August 21, 2013 71 War or Dates No
I Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address Albany Medical Center
pManner of Death Natural Undetermined ❑ Pending
V ® Cause ❑ Accident ❑ Homicide ❑ Suicide Circumstances Investigation
0 Medical Certifier Name Title
0 Vladimir Davidyuk MD
Address
43 New Scotland Ave., Albany, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1607
Date Cemetery or Crematory
❑ Burial
August 23, 2013 Pine View Crematorium
❑ Entombment g
® Cremation Address
Queensbury, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
H Hold
CO
Q Date Point of
tl Transportation Shipment
to ❑ By Common
5 Carrier Destination
ElDate Cemetery Address
Disinterment
Date Cemetery Address
0 Reinterment
Permit Issued To Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
Address
Ce
0- Permission is hereby granted to dispose of the human remains described abo as indicated- / )
Date August 22, 20137 ,{ C, . V P
Registrar of Vital Statistics
Issued (signs re)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z',' Date of Disposition 'aG'/3 Place of Disposition /?i16C (/rj AJ Ce...ir,n4 AV
W (address)
E
W''
co
re (section) , (lot ,• ber) (grave number)
0
W Name of Sexton or rso in C of Premises
s�7_L L j..,,,J ,4,-,
(please print)Signature /144 Title (2a001a4 4-57
L.
(over)
DOH-1555 (02/2004)