Baldwin, Lucille t _ : `11
NEW YORK STATE DEPARTMENT OF HEALTH 31
Vital Records Section Burial - Transit ermit
` `'` Name First Middle Last Sex
Lucille Elizabeth Baldwin Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 18,2017 98 War or Dates NA
Place of Death Hospital, Institution or
City, Town or Village City of Glens Falls, NY Street Address The Pines At Glens Falls
,•;:: Manner of Death ❑X Natural Cause n Accident ❑Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
(' Medical Certifier Name Title
,ri_ Joanne Cooper PA
, Address
170 Warren Street, Glens Falls,NY 12801
ZiO Death Certificate Filed District Number / Register Number
City, Town or Village City of Glens Falls,NY 560 ( Z -�
❑Burial Date Cemetery or Crematory
❑Entombment April 20, 2017 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
U)
0 Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Ti Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
+': Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
Address
yr 94 Saratoga Avenue, South Glens Falls,NY 12803
lii Name of Funeral Firm Making Disposition or to Whom
t_ N Remains are Shipped, If Other than Above
' -, Address
Permission is hereby granted to dispose of the human remains described above as indicated.
1 Date Issued Li / t c1 (Li -7 Registrar of Vital Statistics likia_ ,-yQ W
(74
(signt re)
0' District Number )60 ( Place 6 ( 'v S, I`,s��y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W2E �Date of Disposition fri 2 .7ellace of Disposition � Q�,j,�' ,�'oCNIA,
W /! (address)
N
0 (section) A^ (iit number) (� (grave number)
ca Name of Sexton or Person in Charge of Pre ises �
" n I I
Z (p ase print)
Signature tLIJ
Title fem t,
(over)
DOH-1555(02/2004)