Tennant, Sandra Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sandra Ann Tennant Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2020 74 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 60A Broad Street,Glens Falls,New York 12801
p Mannerof Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending
VCircumstances Investigation
QW Medical Certifier Name Title
Kyle Leonard MD
Address
9 Carey Road,Queensbury Town, New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 29
Burial Date Cemetery,Crematory or Facility Name
01/15/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z ❑Removal Date Place Removed
and/or and/or Held
F N Hold Address
O
t1 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
F— Remains are Shipped,If Other than Above
Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/15/2020 Registrar of Vital Statistics RWertf3nYrewCutt&(E§ctrvnwaQSigneq)
(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:
H
Z Date of Disposition 0 L Place of Disposition z If
W f
2 (address)
W
N (section) (lot number) (gravenumber)
Q
Name of Sexton or Person in Ch a of Premise ll
Z / ease pant)
W Signature Title
DO H-1555(o7/18)p 1 of 2
y
Public Health Law Sec. 4145(2b) 013?-5 8
Receipt
Human remains of �`' delivered on ' , 20
e
Pine View Cemetery Representing the funeral home name .onbuji�l permit
Official Funeral Directors Reg.or License# '