Loading...
Thibodeau, Barbara 01 ti c----) ( L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Thibodeau Female Date of Death Age If Veteran of U.S.Armed Forces, 06/25/2023 83 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing p Manner of Death Z Natural Cause Accident 0 Homicide El Suicide Undetermined Pending III 0 Circumstances Investigation WL Medical Certifier Name Title Jennifer Donovan DO Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 97 BurialH Date Cemetery,Crematory or Facility Name 06/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation oz❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 d Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped,If Other than Above Address Cr W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/27/2023 Registrar of Vital Statistics Caroliine9fifgari Bar6er(EkctronicaLySigned) (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: W k Date of Disposition (G g(Z3 Place of Disposition ,_,_,(_ l- 2 (address) W U) fr (section) 7 (lot number) (grave number) O Name of Sexton or Person in Charge of Premises /' r L (i f ,Z (p se print) W Signature ` Title ��'r`'�tl / _ - DOH-15551o7/18)pi of 2 J 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#