Coon, Bettina L. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bettina L.Coon Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/14/2020 94 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 71 Longview Drive#277,Queensbury Town, New York 12804
LU
`p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined ❑Pending
U Circumstances Investigation
LLII Medical Certifier Name Title
Robert Love MD
Address
3 Irongate Center,Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 69
Burial Date Cemetery,Crematory or Facility Name
04/15/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
Z Date Place Removed
O Removal
and/or and/or Held
N
Hold Address
O
(L 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 Otherthan Above
Address
tu
4' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/15/2020 Registrar of Vital Statistics Carofi'nexfdeqarde BarAer(Elertronicag Signed
(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 1�f
Z Date of Disposition l Ifs Z(� Place of Disposition L !0�
2 /address/
W
CO)
M (section) (lot number) (grave number)
13 Name of Sexton or Person in Charge of7Pmises ry h44ft
Z /pl se print/
l!I Signature Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0? 3 5 3 2.
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#