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Durkish, Barbara Jo III/ NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Barbara Jo Durkish Female Date of Death Age If Veteran of U.S.Armed Forces, 01/28/2021 60 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Accident Homicide Suicide W Undetermined Pending (3 Circumstances Investigation QW Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 63 ElBurial Date Cemetery,Crematory or Facility Name 01/30/2021 Pine View Cemetery Ei Entombment Address 0 Cremation Queensbury Hamlet,New York EjDonation ❑Removal Date Place Removed „- and/or and/or Held N Hold Address 0 N❑Transportation Date Point of G by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address CC W Ct' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/29/2021 Registrar of Vital Statistics Wp6ertAndrew Curtis(ECectronicaIySigned) /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: ZL ILJ Z Date of Disposition 21I 1 7) Place of Disposition ,,, 2 /address/ W (section) //it //otnumber/ /gram number/ Name of Sexton or Person in Charge of P ises tit.,., x 44 z (pl se print) W Signature (-09 �L� Title 1131W DOH-1555(07/18)p 1 of 2 ram., j Public Health Law Sec. 4145(2b) J 14 4 R 1 1 Receipt i Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#,/ ; i .