MacLaren, Barbara Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Ann MacLaren Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/10/2022 82 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause []Accident []Homicide []Suicide []Undetermined ❑Pending
ILI
f 'Circumstances Investigation
WD Medical Certifier Name Title
Aaron Heckler PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 360
[]Burial Date Cemetery,Crematory or Facility Name
07/12/2022 Pine View Crematory
['Entombment Address
Cremation Queensbury Town,New York
LiDonation
0❑Removal Date Place Removed
F- and/or and/or Held
N Hold Address
Q _
d Date Point of
Cl)OTransportation
p by Common Shipment
Carrier Destination
[]Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/12/2022 Registrar of Vital Statistics Megan No('n(ECectronicaCCy 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: yq,,
W 1 "l t/i� , . 'vc.._j
Z Date of Disposition 1 1 14(i L Place of Disposition
(address)
W
CC (section) (lot numbe (grave number)
0 Name of Sexton or Person in Charge of Premises I I 4H
Z - Uplease print
W Signature ' Title { ��C
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 6
Receipt
Human remains of delivered on _. , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#