Sycuro, Barbara Gean ; r: .t-t
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NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Barbara Gean Sycuro Female
Date of Death Age If Veteran of US.Armed Forces,
01/18/2023 82 Years War or Dates
t.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
W Manner of Death Undetermined Pending
O Natural Cause ❑Accident Homicide Suicide g
W
V Circumstances Investigation
0 Medical Certifier Name Title
Jennifer Donovan DO
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 10
Burial Date Cemetery,Crematory or Facility Name
01/20/2023 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
f— Hold Address
CO
0
d Date Point of
(/! Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
• Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/19/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition /eki.0 3 Place of Disposition e,,4) Cr fry(
2 (address) 1
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IC (section) j� (lot n r) (grave number)
Name of Sexton or Person in Charge f Premise 1 ►��m O!J
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(please print
W Signature Title _ V
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DOH-1555(07/18)p 1 of 2
01R 1. 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#