Linendoll, Barbara Jean rit:1....-
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Jane l.inendof Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/06/2022 89 Years War or Dates
H Place of Death Hospital,Institution or
Z City,!own or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
111
`p Manner of Death ElNaturalCause Accident 0Hornicide EI
Suicide DUndeterrnined ❑Pending
O Circumstances Investigation
W Medical Certifier Name Title
ca Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 511
Burial Date Cemetery.Crematory or Facility Name
10/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
ODRernaval Date Place Removed
and/or and/or Held
F.• Hold Address
0
a Date Point of
N El ran sportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
DDisi nterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
-- Remains are Shipped,If Otherthan Above
3 Address
CC
W
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/07/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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:W Date of Disposition jQ-7?Diz Place of Disposition p; 0 ( 0.` e e rem 4--/
vJ-
2 /address/
W
N (section) (lot number/ (gm ve number/
Q
Name of Sexton or Person in Cha of Pre rise r e a'f f1'l 0 4 <' ,,30„,i
O (please print/
W Signature1-37 A Title ,,OrA.
DOH 1555(07/18)p i of 2
fl13O8
Public Health Law Sec. 4145(2b)
Receipt
Human remains of i • delivered on • • , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#I