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Jary, Barbara Ann v . Inc- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Ann Jary Female Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2022 93 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Wilton Town Street Address 60 Waller Road 226,Wilton Town,New York 12831 ILI a Manner of Death ©Natural Cause Accident Homicide 1=1Suicide Undetermined Pending ILICircumstances Investigation Medical Certifier Name Title Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Gansevoort 4569 11 ❑Burial Date Cemetery,Crematory or Facility Name 02/17/2022 Pine View Crematory E Entombment Address ElCremation Queensbury,New York El Donation Removal Date Place Removed and/or and/or Held H Hold Address M ll')❑Transportation Date Point of i Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/16/2022 Registrar of Vital Statistics Susan'Baldwin(E(ectronicalty Signed) (signature) District Number 4569 Place Gansevoort, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition if il lit Place of Disposition Z, 4:).---..- tu r'Z' (address) lIU CO (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premis t L., SO `'a Z .e, 2 (lease print) 1W Signature Title V r(?6 IP( 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#