Paquin, Barbara Clarie 20
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Claire Paquin Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/21/2021 87 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
p Manner of Death II Natural Cause Ei Accident ❑Homicide ❑Suicide El Undetermined Pending
W Circumstances Investigation
W• Medical Certifier Name Title
O Wendy Steinhacker PA
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 54
Burial Date Cemetery,Crematory or Facility Name
02/23/2021 Pine View Crematory
Entombment Address
ElCremation Queensbury Town,New York
ElDonation
• Removal Date Place Removed
and/or and/or Held
Hold Address
CO
0
a Date Point of
co ❑Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment 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
2 Address
Q
W
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/22/2021 Registrar of Vital Statistics Carolinexkfegara Bader(EYectrnnicalySigned)
(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 per •4 !LL
W Date of Disposition 'Z J?3 J Z� Place of Disposition
2 (address)
W
cc (section) jlot number) (grave number)
O Name of Sexton or Person in Charge of Premi //q r - �j^^^,4'}}
Z 4 (p se print)
W Signature Title ri '04
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) �,�.14 5 71.
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#