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Ross ,Barbara V. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara V Ross Female Date of Death Age If Veteran of U.S.Armed Forces, 11/03/2021 81 Years War or Dates Place of Death Hospital,Institution or ZZ City,Town or Village Glens Falls Street Address 1 Towpath Lane,Glens Falls,New York 12801 Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending UCircumstances Investigation Wt] Medical Certifier Name Title Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 488 ❑Burial Date , Cemetery,Crematory or Facility Name 11/05/2021 • Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 U. 1-1 Date Point of CA ❑Transportation CI by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address I:Reinterment 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 ad Address CC Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/05/2021 Registrar of Vital Statistics R96ertAndrew Curtis(ECectronicat(y Signed) (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: Date of Disposition 116. Z/ Place of Disposition c.e Vi e,,0 C1 i 1-v" 2 /addr0L J W CA CC (section) (/ number)�/ / (grave number) Name of Sexton or Person in Cha f Premise - /1//�0 "('� GJa S / �� /please print) 1!J Signature ` �� / �"' Title .01�i',-ft4 r r DOH-1555(07/18)p 1 of 2 1 -4,..,. 4 015 301 Public Health Law Sec. 4145(2b) 1 Receipt 1 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#