Baker, Eileen E NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Eileen E.Baker Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/01/2019 81 Years War or Dates
�.. Place of Death Hospital,Institution or
—7
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death
Ri
W Natural Cause �Accident �Homicide �Suicide �Undetermined �Pending
U Circumstances Investigation
W Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 476
Burial Date Cemetery,Crematory or Facility Name
11/05/2019 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
a Date Point of
N F1 Transportation
p by Common Shipment
Carrier Destination
❑Disinterment Date Cemetery Address
JEJRei nterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
IH Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/04/2019 Registrar of Vital Statistics Wp6ert,IndrewCurtir(—EkctronicalTySWned)
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 1115,111 Place of Disposition0-11
1!1 address/
W
N (section) �� f(/otnumber) (grave number)
12
GName of Sexton or Person in Charge of Premises "� ( eassee
print/Z
W Signature C ;�,L Title
DO H-1555(o7/18)p t of 2
313047
Public Health Law Sec. 4145(2b)
Receipt
Human remains of �/ �.. delivered on^ , 20
r r �
f
Pine View&metery Represef iting.tbe funeral home named on burial permit
Official Funeral Directors Reg.or License# '