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Pratt, Barbara J
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara J Pratt Female Date of Death Age If Veteran of U.S.Armed Forces, 12/26/2020 97 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Bolton Town Street Address 4953 Lakeshore Drive, Bolton Town, New York 12814 0 Manner of Death ©Natural Cause El Accident El Homicide ❑Suicide El Undetermined 0 Pending W C.) Circumstances Investigation W Medical Certifier Name Title Bryan Smead MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Bolton Landing 5650 13 Burial Date Cemetery,Crematory or Facility Name 12/30/2020 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York Donation Z 0 Removal Date Place Removed and/or and/or Held r.0 Hold Address Q a Date Point of N ❑Transportation Shipment S by Common Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address EIReinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom i` Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2020 Registrar of Vital Statistics Jodi G Connally(Efectronicaffy Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition /2-30r'202Q Place of Disposition ?ihk_ U��'u3 Lf�(ades eli W N (section) (lot number) (grave number) CC G Name of Sexton or Person' harge of Premises • 1'�'/' n 4�`ket�c'i` (please print) / W �. Signature Title G71.m y c y-6-7 - / DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01 4 5 7 Receipt t Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#