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Barber, Colleen 1.(,......f): . If 511 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burlap - Transit Permit Name First Middle Last Sex Colleen Barber Female Date of Death Age If Veteran of U.S.Armed Forces, 07/12/2023 62 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 507 Glen Street Apt.#1, Glens Falls, New York 12801 p Manner of Death I:I Natural Cause ❑Accident El Homicide ESuicide ❑Undetermined riPending W U Circumstances Investigation 0 Medical Certifier Name Title William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 342 Burial Date Cemetery,Crematory or Facility Name 07/14/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed F= and/or and/or Held N Hold Address 0 0. Date Point of U) Transportation 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 f— Remains are Shipped,If Other than Above a Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/14/2023 Registrar of Vital Statistics (Megan Wolin(E(ectronica((y Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition 7 i KO Place of Disposition f g `(add ) W U) CC (section) � � lot numbe.� (grave number) _] Name of Sexton or Person in Charge of Premises /'zi — 'f z please print) SignatureIll Title `EGrr1�4t�►4' DOH-1555(o7/i8)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#