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Casey Theresa Eleanor NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Theresa Eleanor Casey Female Date of Death Age If Veteran of U.S.Armed Forces, 02/24/2020 93 Years War or Dates II.— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre p Manner of Death 0 Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 29 ©Burial Date Cemetery,Crematory or Facility Name 02/29/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held H N Hold Address O �- N F]Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment I 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 IM W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/25/2020 Registrar of Vital Statistics Carorne.9Yddkgarae Barger(ElectronicaQ Stgtteq) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— W Date of Disposition 2 1 2 g f 2() lace of Disposition 2 ad ress IW Mohican 1 U) M (section) (lot number) (grave number) Name of Sexton r Person in Charge of Pre ises Connie Goedert Z (Plea a print) W Signature ' Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 010370 Receipt Human remains of delivered on , 20_ f �— Pine View Cemetery (.. �_. Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# CASEY NAME Theresa E. Casey Age:93 Lot Owner:Robert D. & Theresa E. Casey Lot# Grave# 12K Horicon 1 Case: &ncrete Died: 2/24/2020 Interred2/29/2020 Funeral Home: Baker Funeral Home Cemetery: Pine View