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Tanis, Barbara Jane NEW YORKSTATE DEPARTMENT OF HEALTH 1.UF Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Jane Tanis Female Date of Death Age If Veteran of U.S.Armed Forces, 01/20/2021 96 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 30 Country Club Road,Queensbury Town,New York 12804 W Manner of Death © Pending G Natural Cause Accident Homicide Suicide Undetermined W Circumstances Investigation W Medical Certifier Name Title 0 Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 23 ©Burial Date Cemetery,Crematory or Facility Name 01/29/2021 Pine View Cemetery ElEntombment Address ❑Cremation Queensbury Town,New York EjDonation Z 0 Removal Date Place Removed cand/or and/or Held QN Hold Address a Date Point of N Li Transportation Shipment S by Common Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above Address OC IU O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2021 Registrar of Vital Statistics Caroline HYfegarrfe Barber(ECectronicaily Signed) (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: II— W Date of Disposition 1 /29/2021 Place of Disposition 21 Qmaker Rd. Oueensbmry, NY 12804 (address/ W Mohawk 4 &5A 2 N Cr (section) (lot number/ (grave number/ O▪ Name of Sexton or Person in Charge of Premises Connie Goedert (please print) W Signature Title Superintendent DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) ,, 411jI) 012839 Receipt Human remains of delivered on 1, , 20 Pine View Cemetey Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# TANIS NAME Barbara Jane Tanis Age: 96 k L-I Lot Owner: Barbara J. Tanis Lot# Mohawk 4&5A Grave# 2 Case: Concrete Died: 1 /20/2021 Interred. /29/2021 Funeral Home: Regan Denny Stafford Fh Cemetery: Pine View Cemetery