Curtis, Barbara P . 11.-F)
NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara P.Curtis Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/18/2022 100 Years War or Dates
i_ Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
Manner of Death El Natural Cause Accident 0 Homicide ESuicide ❑Undetermined Pending
W Ci ❑
rcumstances Investigation
0
W Medical Certifier Name Title
O James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed Town of Johnsburg District Number Register Number
City,Town or Village 5655 56
Burial Date Cemetery,Crematory or Facility Name
07/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
Fand/or and/or Held
— Hold Address
0
d Date Point of
U)DT ran sportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Re interment
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
S Address
tCCC
a .Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/19/2022 Registrar of Vital Statistics jean.3IContstock(E/ tmnrca11;Stgnedl)
(signature)
District Number 5655 Place Town Of Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7 _I To 17,Z Place of Disposition u yi.._
2 /address/
W
N
Q (section) (lot number) (gram number)
2 Name of Sexton or Person in Chaise of Prem. r itt'
Z /p/ealrin//
Ui Signature _ Title `IA'}j4 Pe
DOH-1555(07/18)pi of 2
,i 6 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#