Loading...
Haldt, Barbara M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records , Name First Middle Last Sex Barbara M.Haldt Female Date of Death Age If Veteran of U.S.Armed Forces, 11/03/2020 101 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address 23 Kenwood Circle,Queensbury Town, New York 12804 UJ Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation a Medical Certifier Name Title 0 Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 203 ❑Burial Date Cemetery,Crematory or Facility Name 11/04/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of U3 ❑Transportation Q by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment ' Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom 1.., Remains are Shipped,If Other than Above aAddress CC W [L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/04/2020 Registrar of Vital Statistics Caroline JfiCclegarrfeBar6er(ECectronica(lySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ]Jf S7?0 Place of Disposition -IL /1"%*-- 2 (address) la NCC (section) /J'ot number) (grave number) 0 Name of Sexton or Person in Charge o remises t" � ✓'�� Z (pleas print) lt! Signature Title ` "� � DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 4 17 4 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#