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Blanchard, Anna J. NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Anna J.Blanchard Female Date of Death Age If Veteran of U.S.Armed Forces, 04/17/2020 86 Years War or Dates II.- Place of Death Hospital,Institution or Z City,Town or Village Edinburg Town Street Address 155 Northville Road, Edinburg Town, New York 12134 pManner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending (Wj Circumstances Investigation UJ Medical Certifier Name Title William Borgos MD Address 161 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Edinburg 4555 3 ❑Burial Date Cemetery,Crematory or Facility Name ❑ 04/21/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held �- Hold Address N 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 Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition orto Whom F- Remains are Shipped,If Other than Above Address tx W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/20/2020 Registrar of Vital Statistics (Denise Ferguson(ECectronica(Cv Signed) /signature/ District Number 4555 Place Edinburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition y-2/-Za9.f� Place of Disposition �i� vi Q e Uj (ad ess) W N M (section) (lot number) (grave number) SName of Sexton or P ' Charge of Premises Z (please print) W Signature Title e nrn � DOH-1555(07/18)fl of 2 Public Health Law Sec. 4145(2b) Q 1 5 8 f Receipt Human remains of a '; i ' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#