Barlow, Gail Agnes NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Pe It
Name First Middle Last Sex
Gail Agnes Barlow Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/12/2021 83 Years War or Dates
i... Place of Death Hospital,Institution
WCity,Town or Village Glens Falls Street Address Gle. Hospital
p Manner of Death Natural Cause Accident ❑Homicide Suici._ Undetermined Ei Pending
W Circumstances Investigation
LU U
0 Medical Certifier Name Title
Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 19
ElBurial Date Cemetery,Crematory or Facility Name
01/14/2021 Pine View Crematory
El Entombment Address
aCremation Queensbury Town,New York
0 Donation
0 ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
O. Date Point of
CO Li Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i-. Remains are Shipped,If Other than Above
m Address
IX
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2021 Registrar of Vital Statistics qZogert,Indrew Curtis(Tlectronical5,Srgned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IN
W Date of Disposition ))51 Zi Place of Disposition -Ftiu_ „>tor—,
2 (address)
W
N
CC (section) lot number) (grave number)
0 Name of Sexton or Person in Cha f PremiseL
/A,.11L._ c Jr`+�ii1
Z (p/ea print)
W Signature /t Title C F1k
g
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 114 41,3
Receipt
Human remains of delivered on_ : , 20
Pine View Cemetery RepresentingAhe funeral home named on burial permit
Official Funeral Directors Reg.or License# •