Gates, Barbara Jean r . # Z-7
NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Jean Gates Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/15/2024 82 Years War or Dates
Place of Death Hospital.Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
1p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Travis Wheeler DO
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed City Of Albany District Number Register Number
City,Town or Village 0101 0640
RBurial Date Cemetery,Crematory or Facility Name
03/18/2024 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
O. Date Point of
U)aTransportation
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
Remains are Shipped,If Other than Above
2 Address
W
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/18/2024 Registrar of Vital Statistics Kew'Bart/°lomew(Ekctronicaly signer°
(signature/
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3t to 114 Place of Disposition FzilloVEv 1-1?‘mA Tu2��
(address)
W
CO
(section) (tot number) cjAu
(grave number)
8 Name of Sexton or Person in Charge of Premises rA.•� �- itt
pease print/
IL Signature �� Title r�etc°„'4
DOH-1555(07/18)p i 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#