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Jeffers, Barbara Joan u: • - 0 #1 S� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Joan Jeffers Female Date of Death Age If Veteran of U.S.Armed Forces, 07/09/2023 88 Years War or Dates ZPlace of Death Hospital,Institution or !LJ City,Town or Village Moreau Town Street Address 6 Ella Drive,Moreau Town,New York 12828 p Manner of Death El Natural Cause Accident Homicide OSuicide Undetermined Pending (W) Circumstances Investigation CI Medical Certifier Name Title Jennifer Stratton MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 37 Burial Date Cemetery,Crematory or Facility Name 07/12/2023 Pine View Cemetery Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed F- and/or and/or Held N Hold Address 0 O. Date Point of U)OTransportation ES Common Shipment Carrier Destination ElDisinterment Date Cemetery Address EiReinterment 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 Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/12/2023 Registrar of Vital Statistics Brenda Jfutter(Electronically Signed) (signature) District Number 4562 Place Town Of Moreau 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 f(1 11 , Place of Disposition 'pi,,,s �,, _ 2 (address) W U) Q (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge o Premises !(\ri (ram .i1-} z (p!e se print/ W Signature Title relk DOH-1555(o7/18)p 1 of 2 b. 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#