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Pratt, Sandra Jane
NEW YORKSTATE DEPARTMENT OF HEALTH BUriat - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra Jane Pratt I Female Date of Death Age If Veteran of U.S.Armed Forces, 11/26/2019 82 Years War or Dates E.. Place of Death Hospital,Institution or W City,Town or Village Bolton Town Street Address 10 Fox Trail Run,Bolton Town,New York 12814 tp Mannerof Death Natural Cause Accident 1:1Homicide Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 F eath Certificate Filed District Number Register Number ity,Town or Village Bolton Landing 5650 11 Burial Date Cemetery,Crematory or Facility Name 11/27/2019 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held NHold Address O a• Date Point of to❑Transportation Shipment Q by Common 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 orto Whom i.. Remains are Shipped,If Other than Above Address Q W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2019 Registrar of Vital Statistics 9W17G Connall gf,--tmnica-5Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f— Z Date of Disposition Place of Disposition g (address) W N (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises r� Z lease riot) /� / P P W Signature ! � c— Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) -. 1 _ Receipt Human remains of delivered on , 20 .- _S. _ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#