Doty, Barbara Ferne 'LF� # --)(j ,
NEW YORK STATE DEPARTMENT OF HEALTH -.. _ - BurialTransit Permi
Bureau of Vital Records
Name First Middle Last Sex
Barbara Feme Doty Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/17/2022 69 Years War or Dates
1,.. Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
ILI• Manner of Death IINaturalCause Accident Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Carrie Miron PA
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed Town Of Fort Edward District Number Register Number
City,Town or Village 5755 67
RBurial Date Cemetery,Crematory or Facility Name
09/20/2022 Pine View Crematorium
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
Q Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
IL Date Point of
(/) Transportation
p by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
EI
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
i— Remains are Shipped,If Other than Above
a Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/20/2022 Registrar of Vital Statistics Aimee L Mahoney(ECectronicalTy Signed)
(signature)
District Number 5755 Place Town Of Fort Edward
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 W Date of Disposition I(ZZ I 21_ Place of Disposition 1,,iV� •-, -r...-^
2 (address)
W
CC (section) (lot numb (grave number)
/
SName of Sexton or Person in Charge of Pr 'ses l A S� µ
Z please print)
W Signature Title 67F rnyt{
DOH-1555(o7/18)p 1 of 2
016 25
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#