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Barden, Sally Ann
. ' NEWYORKSTATEDEPARTMENTOFHEALTH _ i ,� Burial Transit Permi Bureau of Vital Records Name First Middle Last Sex Sally Ann Barden Female Date of Death Age If Veteran of U.S.Armed Forces, 10/28/2021 93 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death © Natural Cause ❑Accident ❑Homicide El Suicide El Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O Brandii Baker NP Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 - 65 ElBurial Date Cemetery,Crematory r - lame 11/01/2021 Pine View Crematory 0 Entombment Address ----0 Cremation .-- Queensbury-Town,New York ❑Donation g— El Removal Date Place Removed and/or and/or Held _ - f- Hold Address CO 0 0. Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination E Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom E.- Remains are Shipped,If Other than Above a Address D: W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2021 Registrar of Vital Statistics Shetfey Mckernon(ECectronicaffy Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— / Z Date of Disposition II 12 Ili Place of Disposition ,e I.J,,_ l r-f W (address) W CC (section) 4 (lot number) (grave number) aName of Sexton or Person in Charge of remises `IG��6-4Syv�"'ttt Z 4..." (41 ease print) W Signature Title lwO w1OI DOH-1555(o7/18)p 1 of 2 1 77 Public Health Law Sec. 4145(2b) Receipt Human remains of j delivered on , 20, Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Dir, ctors Reg.or License# _