Lester, Barbara Ellen Town of Queensbury
Certification of Cremation
V74� Pine View Cemetery and Crematory
This certifies that the remains of: Barbara Ellen Lester
were cremated on December , 29 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death December , 24 20 22 Age 94
(Month) (Day)
Funeral Home Carleton Funeral Home Registered No. 1032
(Authorized Signature)
DOH-1961(8/2011) RECORDED DISTRICT NEW YORK STATE toUor
5755 DEPARTMENT OF HEALTH
REGISTER NUMBER CERTIFICATE OF DEATH 131-2022-00108777
94 STATE FILE NUMBER
1.NAME:FIRST MIDDLE LAST 2.SEX: 3.DATE OF DEATH: YEAR 138.HOUR:
Barbara Ellen Lester Female 12 I 24 2022 I 02:45 PM
4A.PLACE OF DEATH: HOSPITAL HOSPITAL HOSPITAL NURSING PRIVATE HOSPICE OTHER 4B.IF FACILITY,DATE ADMITTED:
(Check one) DOA ER OUTPATIENT INPATIENT HOME RESIDENCE FACILITY (Specify): I MONTH DAY YEAR
❑ ❑ ❑ ❑ IN ❑ ❑ ❑ I 10 01 2019
4C.NAME OF FACILITY:(If not facility,give address) 14D.LOCALITY:(Check one and specify) I 4E.COUNTY OF DEATH:
I CITY VILLAGE TOWN I
Fort Hudson Nursing Center Inc I ❑ ❑ ❑ Fort Edward Town I Washington
4F.MEDICAL RECORD NO. 14G.WAS DECEDENT TRANSFERRED FROM ANOTHER INSTITUTION?(If yes,specify institution name,city or town,county and state)
Q I NO YES
J 3457 I ® ❑
< = 5.DATE OF BIRTH: 6A.AGE IN 6B.IF UNDER 1 YEAR 6C.IF UNDER 1 DAY 7A.CITY AND STATE OF BIRTH:(If not USA,Country and 78.IF AGE UNDER 1 YEAR,NAME OF HOSPITAL OF
�e YEARS: ENTER: ENTER: Region/Province) BIRTH:
6 MONTH DAY YEAR months days hours minutes
V 94 I I
0 a 06 03 1928 yrs. I I Northumberland Town,New York
13 rA 8.SERVED IN U.S.ARMED 9.DECEDENT OF HISPANIC ORIGIN?Check the boxes that best describe whether the decedent is Spanishnlispanic aano. 10.DECEDENT'S RACE:Check one ormore races to indicate what the decedent considered himself or herself to be:
Z d ,ad Z FORCES?(Speedy years)
(/) Cr W NO YES A®No,not SpanishMispanic/Latino B❑Yes,Mexican,Mexican American,Chicano A®White/Caucasian B❑Black or African American C❑Asian Indian D❑Chinese
. ®0 ❑1 c❑Yes.Puerto Rican D❑Yes,Cuban
� ,�(/� U E 0 Filipino F❑Japanese G❑Korean H❑Vietnamese
co r 0 E❑Yes,Other SDanislu'HisDaniclLatino(Specify) J❑Native Hawaiian K 0 Guamanian or Chamorro M❑Samoan
() 11.DECEDENT'S EDUCATION:Check the box that best describes me highest degree orlevelof school cornpletedat me time oldeath.
d N❑American Indian or Alaska Native(specify)
1❑5 8th grade 2 0 9th-12th grade:no diploma 3®High school graduate or GED
L▪ j2 O _ 4 0 Some college credit.but no degree 5❑Associate's degree 6 0 Bachelor's degree P❑Other Asian(specify) R❑Other Pacific Islander(specify)
VCCS L 7 IDMaster's degree 8❑Doctorate/Professional degree S❑Other(specify)
N = 12.SOCIAL SECURITY NUMBER: 13.MARITAL STATUS: 14.SURVIVING SPOUSE:
�+ •f+ NEVER MARRIED MARRIED WIDOWED DIVORCED SEPARATED Enter birth name of spouse
L 't N 056-20-8783 ❑1 ❑2 ®a ❑4 ❑5 it married or separated.
N . 158,USUAL OCCUPATION:(Do not enter retired) 115B.KIND OF BUSINESS OR INDUSTRY: '15C.NAME AND LOCALITY OF COMPANY OR FIRM:
W Seamstress I I
Retail Sewing 'Seams,Hudson Falls,NY
I- ° 16k RESIDENCE: 168.County or Region/Province 16C.LOCALITY:(Check one and specify) 16F.IF CITY OR VILLAGE,IS RESIDENCE
O (State or Country if not USA: CITY VILLAGE TOWN WITHIN CITY OR VILLAGE LIMITS?
Z ii net USA) NY Washington 0 0 0 Fort Edward Town OYES ONO IF NO,SPECIFY TOWN:
16D.STREET AND NUMBER OF RESIDENCE: I 116E.ZIP CODE:
319 Broadway I
112828
17.BIRTH NAME OF FIRST MI LAST 18.BIRTH NAME OF FIRST MI LAST
FATHER/PARENT: MOTHER/PARENT:
James H.Ploof Sr. Thelma Ruth Huntington
19k NAME OF INFORMANT: 119B.MAILING ADDRESS:(include zip code)
Edgar Whaley 13H Sparrowhawk Circle,Clifton Park,NY 12065
20A.1 0 BURIAL 2 XCREMATION 3 O REMOVAL 4❑HOLD 5 O DONATION 1208.PLACE OF BURIAL,CREMATION,REMOVAL OR OTHER DISPOSITION. 120C.LOCATION:(CO Of and state)
MONTH DAY YEAR 1 I
z 6OENTOMBMENT 12 28 2022 I Pine View Crematorium 1 Queensbury Town,New York
1218.REGISTRATION NUMBER:
F_ 21A NAME AND ADDRESS OF FUNERAL HOME: Carleton Funeral Home Inc
co 100281
68 Main Street,P.O.Box 67,Hudson Falls,NY 12839 I
cm 22A NAME OF FUNERAL DIRECTOR: 122B.SIGNATURE OF FUNERAL DIRECTOR: 122C.REGISTRATION NUMBER:
Cassandra S Maille I/ Cassandra S9klailTe ECectrorlicalTySigned !14257
23A.SIGNATURE OF REGISTRAR: 123AB.DATE FILED:DAY r 124A.BURIAL OR REMOVAL PERMIT ISSUED BY: I 2 B.DATE ISSUED r YEAR
PO I I III
ITEMS 25 THRU 33 COMPLETED BY CERTIFYING PHYSICIAN-OR--CORONER/CORONER'S PHYSICIAN OR MEDICAL EXAMINER
25A.CERTIFICATION:To the best of my knowledge,death occurred at the time,date and place and due to the causes stated.
Certifier's Name: License No.: Signature:
2Fiilip,q Gam,TVI(D Month Day Year
Philip J Gara,MD 1137811 I► tECectronicatTySigned' 12 27 2022
Certifier's Title: 01:E Attending Physician 0❑Physician acting on behan of Attending Physician Address:
w 1 0 Coroner 2❑Medical Examiner/Deputy Medical Examiner 319 Broadway,Fort Edward Town,NY 12828
Li Month Day Year
F 25B.II coroner is not a physician,enter Coroners Physician's name&title: License No.: Signature:
CC OF
O 25C.If certifier is not attending physician,enter Attending Physician's name 8 title: License No.: Address:
26A.Attending physician Month Day Year Month Day Year 268.Deceased last seen alive Month Day Year 26C.Pmunounced Month Day Year Time
attended deceased: FROM 1 0 01 2019 To 12 24 2022 by attending physician: 12 21 2022 Dead ON 12 24 2022 AT 02:45 PM
27.MANNER OF DEATH: UNDETERMINED PENDING 28.WAS CASE REFERRED TO 29A.AUTOPSY? 1 298.IF YES,WERE FINDINGS USED TO DETERMINE
NATURAL CAUSE ACCIDENT HOMICIDE SUICIDE CIRCUMSTANCES INVESTIGATION CORONER OR MEDICAL EXAMINER? NO YES REFUSED I CAUSE OF DEATH?
®1 02 03 04 ❑s OR ON NO 1❑YES ®0 01 ❑2 I 00NO 1❑YES
CONFIDENTIAL SEE INSTRUCTION SHEET FOR COMPLETING CAUSE OF DEATH CONFIDENTIAL
APPROXIMATE INTERVAL
30.DEATH WAS CAUSED BY:(ENTER ONLY ONE CAUSE PER LINE FOR(A),(B),AND(C).) BETWEEN ONSET AND DEATH
PART I.IMMEDIATE CAUSE:
IA)failure to thrive 2 months
= DUE TO OR AS A CONSEQUENCE OF:
a (B)Alzheimer's disease 3 years
Ill• DUE TO OR AS A CONSEQUENCE OF:
u. (C)«<>>>
PART II.OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DID TOBACCO USE CONTRIBUTE TO DEATH?
W DEATH BUT NOT RELATED TO CAUSE GIVEN IN PART I(A):hypertension chronic kidney disease diabetes 0®NO 1❑YES 2❑PROBABLY 3❑UNKNOWN
cn
I HOUR: 1 31 B.INJURY LOCALITY:(City or town and county and state) 131C.DESCRIBE HOW INJURY OCCURRED: 13 D.PLACE OF INJURY: 131E.INJURY AT WORK?
Q• 31A IF INJURY,DATE: 1 I I NO YES
U MONTH DAY YEAR I I I I I❑O ❑1
I I I I I
31F.IF TRANSPORTATION INJURY,SPECIFY: 32.WAS DECEDENT 33A.IF FEMALE: 33MBON DATE OF DELIIV,ERY: YEAR
1❑D,ieer/Openlor 20 Passenger 30 Pedestrian HOSPITALIZED IN NO YES 0®Nat pregnant within last year 1❑Pregnant at time of death 2❑Not pregnant,but pregnant whin 42 days of death
4❑OTHER(specify) WO 2 MONTHS?
®0 ❑1 3 0 Not pregnant,but pregnant 43 days to 1 year Wore oath 4 0 Unknown if pregnant within past year
Form No. 01
Record of Interments
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PL00P Lot No. 31 B
kddress 101 Boulevard, Glens Falls, N.Y. — Section No.
Plot Ondawa Ext.
owner M,r_ R. Mrs_ James Pl nnf
Date May 18, 1971
100Superficial ft. @ $2.00.per sq. ft.
Location Bounded on the North by Vacant, East by Vacant. South by lot of Huntington,
West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 1181
Payment Record Paid in full May 18, 1971
ce)-9
Lester
NAME Barbara Ellen LesteOle: 94
Lot Owner:Mr. & Mrs James Ploof
Lot# Ondawa Ext. 31 B Grave# 1
Case: Urn
Died: 1 2.2 4 .2 2 Interred:6 .2.2 3
Funeral Home: Carleton FH
Cemetery: Pine View