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Delong, Jeanne Olive NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last $ex Jeanne Olive DeLong Female Date of Death Age If Veteran of U.S.Armed forces, 12/09/2019 80 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town --TStreet Address The Stanton Nursing And Rehabilitation Centre W Manner of Death Natural Cause Accident Homicide 0 Suicide Undetermined Pending V Circumstances Investigation W Medical Certifier Name Title 0 Suzanne Barth PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 182 ©Burial Date Cemetery,Crematory or Facility Name 12/11/2019 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held ~ Hold Address N O C- Date Point of N❑Transportation 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 II— Remains are Shipped,If Other than Above Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/10/2019 Registrar of Vital Statistics Caro,6neKGlegardeBar6er(E&,tronicalySrgned) (signature/ District Number 5657 Place Queensbury, 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 Q-ti. Iq Place of Disposition"Pyne J��ua r�� �l a1 Qvc�kcR S Wr W � (a dress) W U) (sedi (tot number) (grave number/ a: Name of Sex r Person in Charge of Premises Z' Z (please print) W Signature Title T DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010358 Receipt Human remains o; 9a delivered oRI 20r s ff •• Pine View C ' ete Repre ting the f"uneA home named o b permit Official Funeral Directors Reg.or License# 2 NAME Jeanne Olive Delong Age: 80 Lot Owner: Jeanne DeLong Lot# 8E Horicon Grave# 1 Case: concrete Died: 1 2/9/2 01 9 Interred: 1 2/1 1 /1 9 Funeral Home: Baker Funeral Home Cemetery: Pine View Cemetery