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Maxam, Dorothy E.
NEWYORK STATE DEPARTMENT OF HEALTH Eqb Bureau of Vita Burial - Transit Permit l Records Name First Middle Last Sex Dorothy E.Maxam Female Date of Death Age If Veteran of U.S.Armed Forces, 05/04/2020 83 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Thurman Town Street Address 222 Bowen Hill Road,Thurman Town, New York 12885 p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W U Circumstances Investigation WQ Medical Certifier Name Title Christopher Hoy MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Athol 5659 0003 Burial Date Cemetery,Crematory or Facility Name 05/07/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation 0 Removal Date [Place Removed and/or and/or Held N Hold Address O Un Transportation Date Point of 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 or to Whom 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 05/07/2020 Registrar of Vital Statistics Susan StapCes(ECectronicaCCy Signed /signature/ District Number 5659 Place Athol, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition S 7-ZjZo Place of Disposition 2 /add ess/ W (section) \ (/otnumber) (grave number) Name of Sexton or Person i ha e f Pre ises �J w1 C-rx �, W 6c-"-0 Z (Please print) W Signature Title DOH-1555(07/18)p 1 of Public Health Law Sec. 4145(2b) Receipt t Human remains of delivered on , 20 f Pine View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg.or License#