Glowinski, Claire Frances NEW YORKSTATE DEPARTMENT OF HEALTffi'
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Claire Frances Glowinski Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/20/2019 69 Years War or Dates
Placeof Death Hospital,Institution or
WCity,Town or Village Saratoga Springs TS-
II.- treet Address Saratoga Hospital
p Manner of Death W MR Cause MAccident Homicide Suicide Undetermined Pending C.) Circumstances Investigation
QW Medical Certifier Name Title
Paul Dittes MD
Address
211 Church St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs 4501 686
Burial Date Cemetery,Crematory or Facility Name
12/23/2019 Pine View Crematory
Entombment Address
FKJ Cremation Queensbury Town,New York
Donation
Removal Date Place Removed
F, and/or and/or Held
N Hold Address
0-
IL Date Point of
U) 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
H Remains are Shipped,If Otherthan Above
2 Address
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W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/23/2019 Registrar of Vital Statistics .7ovfn Paul'Franck(ElectronicallySiBnea�
(signature/
District Number 4501 Place Saratoga Springs, 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 l21761IS Place of Disposition
W
2 (address)
W
N
M (section) /ot number/ (grave number)
93 Name of Sexton or Person in Charge of Premises /1 o t.4
Z (p/e e print)
W Signature r Title 6WM4
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DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 913179
Receipt
Human remains of delivered on , 20
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PXe View Cemetery Representing the funeral come named qn .buigi permit
Official Funeral Directors Rep or License# `1