Barber, Dylan Robert NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
•
Bureau of Vital Records
Name First Middle Last Sex
Dylan Robert Barber Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/10/2022 29 Years War or Dates
1— Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 82 Crescent Street 2 3H,Saratoga Springs,New York 12866
W
0 Manner of Death ❑Natural Cause Accident El Homicide Suicide Undetermined ria Pending
W Circumstances Investigation
W Medical Certifier Name Title
C David DeCelle Coroner
Address
40 McMaster Street,Ballston Spa,New York 12020
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 366
Burial Date Cemetery,Crematory or Facility Name
06/14/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal , Date Place Removed
and/or' and/or Held
E— Hold Address
N
0
n- Date Point of
N Dransportation
by Common Shipment
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
—. Remains are Shipped,If Other than Above
2 Address
CC
Ili
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/14/2022 Registrar of Vital Statistics Win:Moran(E(ectronicaCCySigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 1/ ids—
W Date of Disposition ��1��� Place of Disposition � ._
(address)
W
CC N
(section) A (lot number) (grave number)
Name of Sexton or Person in Charge of Pre ' es 1►i 0+ --)4,'"►et er
(pll se print)
Z cp6greC
Signature tU Title
DOH-1555(07/18)p i of 2
Public Health Law Sec. 4145(2b) _ 015 79 0
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#