Baer, Mary Sophine NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Mary Sophie Baer I Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/01/2020 78 Years War or Dates
II.- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
`p Manner of Death LI ®Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 203
Burial Date Cemetery,Crematory or Facility Name
05/06/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
OZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
0- Date Point of
V! Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
j0 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
ll- Remains are Shipped,If Other than Above
S Address
fx
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/05/2020 Registrar of Vital Statistics 12g6ertAndrew Curtis(ECectronicallySiyned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify thatthe remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition -S�7_C� Place of Disposition
uj (address)
2
W
N (section) (lol number) (grave number)
0 Name of Sexton or Per i rge of Premises
Z (please print)
W Signature Title Ue-In 6Z'4V rV z9 X441-)01-11"
DOH-1555(07/18)orl of 2
Public Health Law Sec. 4145(2b) 013706
1
Receipt
i
Human remains of + delivered on , 20
i
c
L.P
e View Cemetery Representing the ft neral home named on burial permit
Official Funeral Directors Reg.or License#