Rousseau, Barbara K NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara K.Rousseau Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/24/2022 82 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Hudson Falls Village Street Address 26 Lincoln Street, Hudson Falls Village, New York 12839
p Manner of Death ❑x Natural Cause Accident 1=I Homicide Suicide Undetermined ElPending
W
O Circumstances Investigation
W Medical Certifier Name Title
O Aqeel Gillani MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed Village Of Hudson Falls District Number Register Number
City,Town or Village 5726 43
Burial Date Cemetery,Crematory or Facility Name
09/26/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
EiDonation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
O
a Date Point of
(I)❑Transportation Shipment
p by Common
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
1— Remains are Shipped,If Other than Above
Address
CC
LU
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2022 Registrar of Vital Statistics Cynthia Bardt'n(E(ectronicaTy Signed)
(signature)
District Number 5726 Place Village Of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
rl '�.e� /4'
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Z Date of Disposition q J18�1 Z Place of Disposition
(address)
W
N CC (section) t� _Slot number)� W� (grave number)
O Name of Sexton or Person in Charge of mises A �- fr
Z please print)
W Signature Title Pf 481"'
DOH-1555(07/18)p t of 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#