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Barlow, Ingeborg NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial-- Transit Permit Name First Middle Last Sex Ingeborg L. Barlow female Date of Death Age If Veteran of U.S. Armed Forces, 08/17/1999 73 War or Dates n/a Place of Death Hospital, Institution or City, 'K(X%X UXX00W Glens Falls Street Address Glens Falls Hospital Manner of Death© Natural Cause 0 Accident Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title Philip J. Gara, MD Address 327 Broadway, Fort Edward, NY 12828 Death Certificate Filed District Number Register,N er City, U1K)UXXIXdW Glens Falls 5601 C� Date Cemetery or Crematory ❑Burial 08/18/1999 Pine View Crematory Address ©Cremation Quaker Road, Queensbury,, NY 12801 Date Place Removed 0❑Removal and/or Held and/or Address ujHold O Date Point of N ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan & Denny Funeral Home 01594 Address 53 Quaker Road, Queensbury, NY 12804 >: Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is he eby granted to dispose of the human remains des ri ed bo as ' c ed. Date Issued S/� !!� Registrar of Vital Statistics (signature) District Number Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- �� I ( W Date of Disposition Place of Disposition /�/1V'0_! 1 i;�4J c��/��r/!n W0 (address) UJI (section) lot number) (grave number) GName of Se xto or Perso in Charge of Premises (please print) p n f >� Signature Title (over) DOH-1555 (9/98)