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Fiel, Maxine L. NEW YORKSTATE DEPARTMENT OF HEALTH �~ ± Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Maxine L Fiel Female Date of Death Age If Veteran of U.S.Armed Forces, 04/25/2020 96 Years War or Dates Place of Death I Hospital,Institution or Z! Ciiy,Town or'v iliage Glens Falls Street Address Glens Falls Hospital W — p= Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending W; Circumstances Investigation U - W Medical Certifier "lame Title Nawed Siddiqui MD ---------- - --- Address iC0 Falk Si, Glans Falb New York 12801 _ Death Certificate Filed District Number Register Numhe: City,To�wn orVillage Glens Falls 5601 188 i Burial`W Date Cemetery,Crematory or Facility Name Pine View Crematory Entonlymen4L Addres [� - i re Gueeisbi-Y Town, New York I ❑ Don�ticr: Z — Place Removed ,eit, dal f 0 and/or Held ~ HUJd - a io ? Date Pointof Shipment r_a '-v Ce-rimon --- - Ca,r� Destrnat:)n Da' Cemetery Address r Date Cemetery Address 3 lei;?*prmpnt i —-----------_ Registration Number ie c.C.i _. Funeral f-,JI s'„er Funeral Home Inc 00211 24 S�,eet PG Dux 500, Lake Luzerne, New York 12846 N<r at FI Making Disposition orto W-:om p. -. >riipp,, i .., . ,,ian Above — — - LL. a' Eby ;,,anted to dispose of the human remains described above as indicated. 9 1 n,tr 0°+=7!202C Registrar of Vital Statistics Fb591 And'6W 01tis(E1eIrCn1d1Y9g-kd --- ----- (signatre) I Place Glens Falls, New York l �W r;v or t ,::,iecedent identifies,above were disposed of in accordance with this permit on: a l— � z o is? 16 Place of Disposition ' f �I1 y L: (address) i W C�Cy-7 (seri,on) (lot number) (grave number) IL i d �d r ,un or son in -narge f Premises P lq�f i (pl se print) i Title c�1t am l Public Health Law Sec. 4145(2b) 0 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#