Finch, Barbara YORK STATE DEPARTMENT OF HEALTH ` ' II 3 N
al Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Harriet Finch Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 18, 2013 80 War or Dates
ti Place of Death Hospital, Institution or
W City, Town or Village Queensbury Street Address WESTMOUNT HEALTH CARE FACILITY
COManner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
LL Circumstances Investigation
Ili Medical Certifier Name Title
CI Bernardo R Villajuan MD,
Address
161 Carey Road Queensbury,NY 12804
Death -.' • ate Filed District Number Regi er Number
Cit , Town or illage ��1 .<74c 1 II
El Bun. Date Cemetery or Crematory
June 20, 2013 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ri Removal and/or Held
and/or Address
E Hold
CO Date Point of
IL 0 Transportation , Shipment
(0 by Common Destination
Q Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
L Remains are Shipped, If Other than Above
Address
CC
Llt
O. Permission is hereby granted to dispose of the human re s described above)a indicated.
bit Issued �Zdl��
Registrar of Vital Statistics ' , C.. IA
(signature)
District Number c(gc"1 Place 1 a V�--, CYC (),,1.1.....ria—&—,dn
1--, I certify that the remains of the decedent identified above were disposed of in aacco nc with this permit on:
W' Date of Disposition b1i1l13 Place of Disposition -8,41)r.Qi, rev,elar00r..
2, (address)
W
ce (section) At,
number) (grave number)
0 Name of Sexton or P son in Char a of Premises l .S�n� -
( print)
W Signature lam- Title C>Z
I.
(over)
DOH-1555 (02/2004)