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Holmgren, Starr G.
�� lD NEW YORKSTATE DEPARTMENT OF HEALTH ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Starr G.Holmgren Female Date of Death Age If Veteran of U.S.Armed Forces, 01/25/2020 87 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 26 Horicon Avenue,Warrensburg Town, New York 12885 Wp Manner of Death © Natural Cause 1:1Accident Homicide Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Shannon Evelis PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 3 ❑Burial Date Cemetery,Crematory or Facility Name 01/28/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held H N Hold Address O IL Date Point of (A ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address IReinterment 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 E— Remains are Shipped,If Other than Above 2 Address cc n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2020 Registrar of Vital Statistics Tamela M GCoyd(ECectronicaCCy Signed) j (signature) j District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H ''II Z Date of Disposition 7 -to Place of Disposition iKVi-Ij W (address/ 2 W ol N (section) (/otnumber/ (grave number) Q a A- 11� S Name of Sexton or Person in Charge of Premises t �v ( ease print) W Signature �/ Title e1 I DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of i delivered on , 20 Pine View Cemetery Representing the" neral home named on burial permit Official Funeral Directors Reg.or License# i i