Carpenter, Inez May #30Z
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Inez May Carpenter Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/31/2020 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
QW Circumstances Investigation
Medical Certifier Name Title
Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 149
Burial Date Cemetery,Crematory or Facility Name
03/31/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
U-N Hold Address
O
d Date --jPoint of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
jo 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
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/02/2020 Registrar of Vital Statistics Wp&rtgndrew('urtu(Eketron-adySy—d)
(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 3 fto Place of Disposition fu___
2 (address)
W
cc N (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of P mises
Z (pl ase print)
W Signature Title ram'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) iJ 13 5 1
Receipt
Human remains of _ delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#.