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Barrows, Eleanor Marie tt- sos NEW YORKSTATE DEPARTMENT OF HEALTH 4, \.•••• Bureau of Vital Records Burial — Transit Permit Name First Middle Last Sex Eleanor Mane Barrows Female Date of Death Age If Veteran of U.S.Armed Forces, 06/15/2023 89 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Lake Luzerne Town Street Address 1787 Call Street, Lake Luzerne Town, New York 12846 p Manner of Death El Natural Cause Accident ri Homicide Suicide nUndetermined ❑Pending o Circumstances Investigation QW Medical Certifier Name Title Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Lake Luzerne District Number Register Number City,Town or Village 5656 8 Burial Date Cemetery,Crematory or Facility Name 06/19/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed F and/or and/or Held Hold Address 0 O. Date Point of N ETransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/16/2023 Registrar of Vital Statistics Cynthia Sherwood-(ECectronicaCCy Signed) (signature) District Number 5656 Place Town Of Lake Luzerne I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 417Z(13 Place of Disposition (�, (address) W N CC (section) (lot number) (grave number) GName of Sexton or Person in Charge of Premises �^ L till Z (lease print/ W Signature ( i Title �fR F/Ih DOH-1555(07/i8)p t of 2 • al.7054 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#—