Loading...
Barber, Douglas Scott (K NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas Scott Barber Male Date of Death Age If Veteran of U.S.Armed Forces, 04/15/2021 62 Years War or Dates i.._ Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 39 Coleman Avenue,Hudson Falls Village,New York 12839 W Manner of Death © W Natural Cause El Accident Homicide El Suicide 0 Undetermined 0 Pending U Circumstances Investigation W Medical Certifier Name Title CI David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 6 ❑Burial Date Cemetery,Crematory or Facility Name 04/17/2021 Pine View Crematorium ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation zRemoval Date Place Removed and/or and/or Held N Hold Address O d Date Point of t/) Li Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped,If Other than Above Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/16/2021 Registrar of Vital Statistics Cynthia Bardin(ECectronically Signed) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 4/ 7_�j1 Place of Disposition �� (/; C Pi?) -��.; 2 (address) W (section) (lot number (grave number) o Name of Sexton or Person in Char a of Premises . 1�'f Ma t/oz. ci / (please print) W Signature � j i yd / Title DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 01 472,4 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named,on burial permit Official Funeral Directors Reg.or License#