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Lane, Barbara R NEW YORK STATE DEPARTMENT OF HEALTH 41 -Plii Vital Records Section Burial - Transit Permit Name First Middle Last Sex Barbara Elizabeth Lane Female Date of Death Age If Veteran of U.S. Armed Forces, 12/05/2013 75 years War or Dates }:- Place of Death Hospital, Institution or Ti City, ARXDPORXX Saratoga Springs Street Address Sara a Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide 0 Suicide Q Undetermined Pending lit Circumstances Investigation W Medical Certifier Name Title Desmond Del Giacco M D Address 59 Myrtle St, Saratoga Springs, N Y 12866 i> Death Certificate Filed District Number Register Number City, rX XX Saratoga Springs 4501 502 ❑Burial Date Cemetery or Crematory ❑Entombment 12/06/2013 • Pine View Cemetery Address :-;:i©Cremation Queensbury N Y . Date Place Removed Removal and/or Held and/or 1. Address tf Hold 0 Date Point of EZ` Transportation Shipment 0 by Common Destination Carrier • Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Compassionate Care, Inc. 00364 Address 402 Maple Avenue, Saratoga Springs, N Y 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IL 17 Permission is hereby granted to dispose of the human remain scri ed aye a indicate . Date Issued 12/06/2013 Registrar of Vital Statistics '"11 (signature) District Number 4501 Place Saratoga Springs >:::::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI Date of Disposition ka-` t3 Place of Disposition h�.eUw , torte (address) ttif tfl M (section) 4(lot number) (grave number) ti Name of Sexton or Perso in Charge f Premises '� .. � +,� 1 ,tr"- 2 (pie se print) Signature IL Title ali tX (over) DOH-1555 (02/2004)