Venon, Barbara Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Ann Venon Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/06/2022 98 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 30 Kensington Road,Glens Falls, New York 12801
W• Manner of Death
Natural Cause Accident El Homicide Suicide El Undetermined Pending
U Circumstances Investigation
Q Medical Certifier Name Title
Sean Campanie NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 85
❑Burial Date Cemetery,Crematory or Facility Name
02/08/2022 Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
12 Donation
Z rj Removal Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
U) 11 Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/08/2022 Registrar of Vital Statistics Megan 1oln(ElectronicalT 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:
l—
W Date of Disposition —10—?�;4 Place of Disposition Inc V iCam/ C/Ctibv4 OrY
address)
W
N
Q (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises 'rm emsY q,11 i(L
Z (please print)
IlJ Signature Title cdoC
DOH-1555(07/18)p 1 of 2
1 0 3_ 5 1'2 2 8
Public Health Law Sec. 4145(2b)
1 Receipt
Human remains of s; t,``t t ^ ° delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#