Colvin, Barbara (LF
NEW YORK STATE DEPARTMENT OF HEALTH .-`' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Colvin Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/17/2022 72 Years War or Dates _
i_ Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 320 Pucker Street,Warrensburg Town, New York 12885
w Manner of Death Undetermined Pending
W []Natural Cause []Accident �Homicide []Suicide � [] g
U Circumstances Investigation
W Medical Certifier Name Title
CI Sean Campanie NP
Address
9 Carey Road, Queensbury Town,New York 12804
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 20
FiBurial Date Cemetery,Crematory or Facility Name
11/19/2022 Pine View Crematorium
Entombment Address
[]Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
F— Hold Address
N
0
CL Date Point of
(I)oTransportation
p by Common Shipment
Carrier Destination
[]Disinterment
Date Cemetery Address
C 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
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/18/2022 Registrar of Vital Statistics (Pamela 9NG(oyc((E(ectronica((ySigned)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— 41"--
Z Date of Disposition lIl2Il 11 Place of Disposition Z L
g (address)
w
CC (section) ! ant number) avw (grave number)
tif-
O Name of Sexton or Person in Charge of P - es ° �--�
Z (+pease print)
alSignature Title lrOlHrK
DOH-1555(07/18)p 1 of 2
r/16d18
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# '