Barrett, Barbara Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Ann Barrett Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/20/2022 74 Years War or Dates
ZPlace of Death Hospital,Institution or
W City,Town or Village Albany Street Address St Peters Hospital
p Manner of Death n Natural Cause []Accident ❑Homicide []Suicide []Undetermined []Pending
U1 I Circumstances / /Investigation
WD Medical Certifier Name Title
Soon Park MD
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 1730
TBurial Date I Cemetery,Crematory or Facility Name
07/26/2022 Pine View Crematorium
[Entombment Address
Cremation Queensbury Town,New York
Donation
0Z❑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
l l 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
I.— Remains are Shipped,If Other than Above
'S Address
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/25/2022 Registrar of Vital Statistics rUanie1Ce S Gillespie((Electronically Signed)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition Z_zo zZ Place of Disposition e i e J Cre h�
2 (a dress)
W
N
CC (section) I (/o umber) (grave number)
Name of Sexton or Person in Char of Prem. s rv4� daeid
Z (please print)
W Signature
g /✓ Title bPPS4.415�
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine/View Cemetery Representing the funeral home namedon,b9rial_.�ermit
Official Funeral Directors Re or License# 7