Lester,Barbara Ellen DEPARTMENT OF H EALTH (17:F) -
NEW YORKSTATE BurialTransit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Ellen Lester Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/24/2022 94 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
p• Manner of Death II Natural Cause Accident Homicide Suicide Undetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
Philip Gara MD
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 94
Burial Date Cemetery,Crematory or Facility Name
12/28/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
z❑Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
G. Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
EDisinterment Date Cemetery Address
OReinterment 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
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2022 Registrar of Vital Statistics Aimee G Mahoney(ECectronica1Ty 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:
W Date of Disposition /2-29•-Z�Zz Place of Disposition pi
2 (address)
W
CC (section) (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises le7-0 11;'fJ ov
Z (please print)
W --�
Signature / / Title
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 named on burial permit
Official Funeral Directors Reg.or License#