Broadus, Barbara 1L g
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NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Broadus Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/23/2020 93 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Amsterdam Town Street Address Capstone Center For Rehabilitation And Nursing
p Manner of Death Natural Cause Accident Ei Homicide Suicide Li
r—IUndetermined ❑Pending
(W,) Circumstances Investigation
WQ Medical Certifier Name Title
Adetutu Adetona MD
Address
302 Swart Hill Rd,Amsterdam,New York 12010
Death Certificate Filed District Number Register Number
City,Town or Village Amsterdam 2850 117
Burial Date Cemetery,Crematory or Facility Name
11/02/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
0
Date Point of
Cl) j Transportation
by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
Address
CC
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/27/2020 Registrar of Vital Statistics Lima Barton-7fuglcer(Ekctronica8 49ne4
(signature)
District Number 2850 Place Amsterdam, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ��J y I Z!! Place of Disposition
2 (address)
CC (section) 7 (tot number (grave number)
0 Name of Sexton or Person in Charge of Premi s �A'. Dvin��r
Z / ease print) /
W Signature L Title IZei
ttrp�
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
014170
Receipt
Human remains of delivered on ' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#