Corbett, Barbara L. /313
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara L Corbett Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/15/2020 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Northumberland Town Street Address 1903 Route 32 North,Northumberland Town,New York 12831
W Manner of Death Undetermined Pending
0 Natural Cause �Accident El �Suicide
W Circumstances Investigation
W Medical Certifier Name Title
CI Robert Reeves MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Northumberland Town 4563 20
Burial Date Cemetery,Crematory or Facility Name
12/17/2020 Pine View Crematory
ElEntombment Address
lCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
6 and/or and/or Held
F- Hold Address
O. Date Point of
(/) ❑Transportation Shipment
S by Common
Carrier Destination
El Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/16/2020 Registrar of Vital Statistics Denise 0 Murphy(Etectronicaliy Signed)
(signature)
District Number 4563 Place Northumberland Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
on �
W Date of Disposition ;�p.2i> � �l Place of Disposition �� �;��,� �1— �c. o✓"`'k
(addres l3
2
W
(n (section) (lot number)/ (grave number)
O Name of Sexton or Person in Ch e of Premi ? y/yl�'r✓i L /oC�
(please print)
W Signature Title 70-4Adc
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b) 014303
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#