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Jameson, Barbara Jane •fi 17° NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara Jane Jameson Female Date of Death Age If Veteran of US.Armed Forces, 09/24/2023 92 Years War or Dates Place of Death Hospital,Institution or 2 City,Town or Village Queensbury Town Street Address 172 Sunnyside Road,Queensbury Town,New York 12804 IJJ p Manner of Death Natural Cause Accident Ei Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 151 Burial Date Cemetery,Crematory or Facility Name 09/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held - Hold Address Transportation Date Point of Q by Common Shipment Carrier Destination 111 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 IH Remains are Shipped,If Other than Above 2 Address Q IW Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/27/2023 Registrar of Vital Statistics Caroline x[fegarde Barber(E(ectronicalfy Signed) (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: Date of Disposition q I n f Z 3 Place of Disposition , v—if J tr Bola NtT��U�J (a dress) // W CC (section) /71 (lotnumberK (grave number) 8 Name of Sexton or Person in Charge of Premi r�� �►— tii' Z (4fease print) W Signature _ P Title DOH-1555(07/18)p t of 2 fit:. ¢ L tea 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#