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Ryan, Carole A.
f NEW YORKSTATE DEPARTMENT OF HEALTH Z I. - � Burial - Transit Permit Bureau of Vital Records • Name First Middle Last Sex Carole A.Ryan Female Date of Death Age If Veteran of U.S.Armed Forces, 03/04/2020 74 Years War or Dates II.— Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Burke Drive 241, Queensbury Town, New York 12804 p Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending 0 W Circumstances Investigation Medical Certifier Name Title Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number ----7 City,Town or Villa a Queensbury 5657 39 Burial Date Cemetery,Crematory or Facility Name 03/10/2020 Pine View Crematory Entombment Address nCremation Queensbury Town,New York Donation zRemoval Date Place Removed F= and/or and/or Held N Hold Address O I (L Date Point of to Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment 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 F— Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/09/2020 Registrar of Vital Statistics CaroCine.7fiCdegarde Barber(ECectronicaCCySigned) (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: H Z Date of Disposition ,3-/G—� y�, Place of Disposition `n� � Gr W 2 (address/ W N Q (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises �,l"e,s Z (please print) W Signature Title C.J-C/3'q-M1- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 13 4 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funer home named on burial permit Official Funeral Directors Reg.or License#