Paul, Marie Ann NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marie Ann Paul I Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/07/2019 94 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
p Manner of Death n Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Kenneth France MD
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 525
Burial Date Cemetery,Crematory or Facility Name
12/09/2019 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
QRemoval Date Place Removed
and/or and/or Held
H N Hold Address
dTransportation Date Point of
N � Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
F—IReinterment
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
�.. Remains are Shipped,If Other than Above
Address
W
(L Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/09/2019 Registrar of Vital Statistics 9&6ett-Inr*'Cutt&(EkctmnicadyS6,ne4
(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:
Date of Disposition IZ iio l ly Place of Disposition LLI (address) rN
g
W
N (section) !ot number/ (grave number)
Q Name of Sexton or Person in Charge of Premises is S kw(it
Q
9 (plea a print)
Z �n
W Signature Title
DOH-1555(07/18)p t of 2
L 1
Public Health Law Sec. 4145(2b) - 1.3 131
Receipt
Human remains of "' sly ��;.�f delivered on , 20
Pine View Cemetery Repres ng the funeral-home named on burial permit
Official FunerarDirectors Reg.or License#
I'
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