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Smith, Joan Barber ► 3(3 NEW YORK STATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan Barber Smith Female Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2021 91 Years War or Dates i.. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 275 Chestnut Ridge Road,Queensbury Town,New York 12804 CU 'p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title G Sharon Shannon NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 97 ❑Burial Date Cemetery,Crematory or Facility Name 04/22/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held N Hold Address O a Date Point of co ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address ID Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above a Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/22/2021 Registrar of Vital Statistics Caroline.7fi&Iegarrfe Barber(E(ectronicaltySigned) (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: Z Date of Disposition U�it3I it Place of Disposition o (address) W Co (section) (ir -oL(lot number) (grave number) elName of Sexton or Person in Charge of Pre ' es L,.) 41 Zease print) W Signature '` _�� Title (YrPrO[ DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 014 731 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#