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Richmond, Barbara L NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Barbara L.Richmond Female Date of Death Age If Veteran of U.S.Armed Forces, 02/18/2024 77 Years War or Dates F.- Place of Death Hospital,Institution or Z City,Town or Village Corinth Town Street Address 364 West Maple Street Apt.214,Corinth Town,New York 12822 W p Manner of Death 111 El Natural Cause Accident 0 Homicide ❑Suicide Undetermined ❑Pending UCircumstances Investigation Q Medical Certifier Name Title John Pezzulo DO Address 211 Church St,Saratoga Springs, New York 12866 Death Certificate Filed Town Of Corinth District Number • Register Number City,Town or Village 4553 9 BurialEd Date Cemetery,Crematory of Facility Name 02/20/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town, New York Donation Z❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 a Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination o Disinterment Date Cemetery Address Reinterment Date Cemetery Address i Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/20/2024 Registrar of Vital Statistics Brenda L Peris(E Iectronically Signed) (signature) District Number 4553 Place Town Of Corinth I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z � - W Date of Disposition 2 22 IN Place of Disposition t DJ,v�f_v ((*.d;'rl(T4E3v� 2 (address) W Cr (section) (lot number) (grave number) gName of Sexton or Person in Charge of e ' es 71! _ 4 Z / lease print11.1 / Signature Title ( Z a • 7/ DOH-1555(07/18)p 1 of 2 • 7nOr Public Health Law Sec. 4145(2b) 1 Receipt 1 I Human remains of delivered on , 20 1 1 1 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#