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Flynn, Barbara D • - —3 g5 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara D. Flynn Female Date of Death Age If Veteran of U.S.Armed Forces, 04/28/2023 86 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Indian Lake Town Street Address 6249 State Route 30, Indian Lake Town, New York 12842 1p Manner of Death El Natural Cause Accident ElHomicide ESuicide Undetermined ❑Pending C.) Circumstances Investigation W Medical Certifier Name Title CI Matthew Miller Coroner Address P.O.Box 250, Indian Lake,New York 12842 Death Certificate Filed Town Of Indian Lake District Number Register Number City,Town or Village 2053 4 Burial Date Cemetery,Crematory or Facility Name 05/02/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation O�Removal Date Place Removed and/or and/or Held H Hold Address 0 O. Date Point of U)❑Transportation Shipment by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/02/2023 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Town Of Indian Lake I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l-WDate of Disposition s i 3 I Z3 Place of Disposition 1 2 (address) ILI NCC (section) ,/(j (lot number) (grave number) Name of Sexton or Person in Charge Premises /f+'�' � Z , lease print) W Signature Title o2 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#