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King, Eleanor Doris NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records r Name First Middle Last Sex Eleanor Doris King Female ' Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2020 73 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 13 Nawed Siddiqui MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 61 © Burial Date Cemetery,Crematory or Facility Name 02/07/2020 Pine View Cemetery Entombment Address ❑Cremation Queensbury Town, New York ❑ Donation z Removal Date Place Removed and/or and/or Held H N Hold Address O a 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 Remains are Shipped,If Other than Above Address cc W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2020 Registrar of Vital Statistics T A,,t.7ndrewCu&-(ElectronicallySy-,4 (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: Z Date of Disposition 2/7/2 0 2 OPlace of Disposition 21 Quarker Rd. Queensbury NY UJI (address) 2 W Horicon 4I i N (section) (lot number) (grave number) Ir aName of Sexto r Person in Charge of Premises Connie Goedert Z ( ease print/ W Signatures Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010366 Receipt delivered on . Human remains of 20 Pine View Cepjetery Representing the funeral home named op burial permit . Official Funeral Directors Reg.or License#