Fictner, Barbara Jean LF
•
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Jean Fichtner Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/26/2022 73 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death I^ I Natural Cause Accident 11 Homicide Suicide FlUndetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Asim Chaudry MD
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 395
[]Burial Date I Cemetery,Crematory or Facility Name
07/28/2022 I Pine View Crematorium
Entombment Address
[]Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
- and/or and/or Held
- Hold Address
0
d Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
[]Disinterment
Date Cemetery Address
Date Cemetery Address
C Reinterment
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
Address
Cr
uJ
▪ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/28/2022 Registrar of Vital Statistics Wlegan NoCin(ECectronica1Ty 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:
Z Date of Disposition 7129ZeZe Place of Disposition pi de Vie CrO 4a40r�
11.1
2 (address)
W
NCC (section) (lot n ber) (grave number)
g Name of Sexton or Person in Charge Premi es Tr►"�m0�1� L ADQ
i
Z (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
;yf
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#