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Hall, Barbara Myrtle NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Myrtle Hall Female Date of Death ' Age If Veteran of U.S.Armed Forces, 01/25/2022 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Valatie Village Street Address Bamwell Nursing And Rehabilitation Center W Manner of Death Undetermined Pending � ©Natural Cause �Accident �Homicide �Suicide W Circumstances Investigation W Medical Certifier Name Title 13 Kathleen Steiger NP Address 3230 Church St,Valatie Village,New York 12184 Death Certificate Filed District Number Register Number City,Town or Village Valatie Village 1023 11 ❑Burial Date Cemetery,Crematory or Facility Name 01/27/2022 Pine View Crematorium ❑Entombment Address ©Cremation Queensbury Town,New York ElDonation ZO ❑Removal Date Place Removed - and/or and/or Held F—- Hold Address N Q a Date Point of CO ❑Transportation Shipment p by Common 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 H Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/26/2022 Registrar of Vital Statistics Barbara Ann Tischer(ECectronica1ySigned) (signature) District Number 1023 Place Valatie Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- W Date of Disposition /I lqt tL Place of Disposition /a....0 %C� .-- W (section) (d'L umber) (grave number) 8 Name of Sexton or Person in Charge f Premises � �t4µft Z Zi } (pleastl fW Signature Title C 'r" TVit DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on,burial.permit Official Funeral Directors Reg.or License#