Bowe, Julie , I% 4 g5 7
NEW YORK STATE DEPARTMENT OF HEALTH / >— 3 ,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
iiJulie Marie Bowe Female
{ Date of Death Age If Veteran of U.S. Armed Forces,
4
' 11/09/2017 66 Years War or Dates
•i�"; Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
. Manner of Death a Natural Cause El Accident El Homicide 1=ISuicide Undetermined El Pending
_ Circumstances Investigation
Prl Medical Certifier Name Title
Raju Sadal PA
' Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 582
❑Burial Date Cemetery or Crematory
w 11/14/2017 Pine View Crematory
i.+, a ❑Entombment Address
'ail®Cremation Quensbury, New York
>' Date Place Removed
r ; ❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
:44., Carrier
g` Date Cemetery Address
❑
* Disinterment
im❑Reinterment
Date Cemetery Address
p. Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
-uF Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
i Date Issued 11/14/2017 Registrar of Vital Statistics 4R9bertACurtis E1f ctrarncaaysigned
(signature)
District Number 5601 Place Glens Falls, New York
K.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition #1 JS�jr) Place of Disposition ENti„ --►nf�,�,
E.$T (address)
ice-
(section) (lot number) (� (grave number)
.. Name of Sexton or Person in Charge of Premi s /IfU �/i^�`e
/�� (pl se print)
,, Signature �^'t Title trkF Vn—
(over)
DOH-1555 (02/2004)