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Baker, Barbara Ann
it- --) 2_,NEW YORK STATE DEPARTMENT OF HEALTH ' Bureau of Vital Records Burial - Transit Perr mit Name First Middle Last Sex Barbara Ann Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 02/15/2024 94 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 198 Bluebird Road, Moreau Town, New York 12803 p▪ Manner of Death Z Natural Cause Accident El Homicide Suicide Undetermined InPending W U Circumstances Investigation lU Medical Certifier Name Title O Madison Zuis NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 13 Burial Date Cemetery,Crematory or Facility Name 02/16/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York II1Donation 0Z❑Removal Date Place Removed and/or and/or Held f- Hold Address N 0 a Date Point of N❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address Disinterment Ei Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom f._ Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2024 Registrar of Vital Statistics Brenda 7futter(ECectronica1CySigned) (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: H W Date of Disposition /�2t>.? c/ Place of Disposition �t,J P U!et.0 ('rYinde,t1 c-\ (address) J W NCC (section) (lot number) (grave number) O Name of Sexton or Person in Charge -Pre 'se tl1�l1dv1L7 (1 o (please print) z I al Signature �6 fj ` ' Title /� e'r'—!i`f� DOH-1555(07/18)p 1 of 2 A > - 7"{ 7 I 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#