Thomas, Barbara Anna ols )1 Z-23
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Anna Thomas Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/26/2022 89 Years War or Dates
i— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
p Manner of Death ID Natural Cause ❑Accident Homicide Suicide ❑Undetermined Pending
W Circumstances Investigation
Medical Certifier Name Title
Gwendolyn Mortis-Dickinson PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens FaNs DistriffNamber Register Number
Ci ,Town or Village 5601 182
Burial Date Cemetery,Crematory or Facility Name
03/29/2022 Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
Donation
goRemoval Date Place Removed
p and/or and/or Held
N Hold Address
0
O. Date Point of
to❑Transportation
a by Common Shipment
Carrier Destination
Disinterment 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
-. Remains are Shipped,If Other than Above
Address
CC
111
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/28/2022 Registrar of Vital Statistics 5Kegan Nola(E/ktr .Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition13c ?I_ Place of Disposition
.7,1L A— .
2 (address)
WI
COCr (section) (lot number) a (grave number)
2 Name of Sexton or Person in Charge of Pre ' s /1 I L �01,tllf
Z /pase print/
"' 2 4�14 f of .-,
Signature Title 4
DOH-1555(07/18)pi.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#