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Barnes, Breanna Lee NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Breanna Lee Barnes Female Date of Death Age If Veteran of U.S.Armed Forces, 09/10/2021 19 Years War or Dates Place of Death Hospital,Institution or W• City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death ©Natural Cause 0 Accident Homicide 1=1Suicide El Undetermined 1=1Pending Circumstances Investigation Iv Medical Certifier Name Title Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 401 O Burial Date Cemetery,Crematory or Facility Name 09/16/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York Donation O Removal Date Place Removed and/or and/or Held H Hold Address CO 0 IL 1-1 Date Point of to Li Transportation tj by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/16/2021 Registrar of Vital Statistics W96ert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Fails, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WVDate of Disposition y//?/2 i Place of Disposition 9;nt, j r C-c,r,�,kcy X (address) W In (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises J ex,".,(.}` SLV ScL S Z (please print) W Signature '� Title Cre,n 40r)e DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of !- delivered on , 20 � � / . ,, ne View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#