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Coleman, Muriel M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Muriel M.Coleman Female Date of Death Age If Veteran of U.S.Armed Forces, 05/17/2020 92 Years War or Dates Il— Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 10 High Pines Terrace D,Warrensburg Town,New York 12817 W Manner of Death Undetermined Pending 0 ® Natural Cause Accident Homicide Suicide W Circumstances Investigation U W Medical Certifier Name Title In Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 11 Burial Date Cemetery,Crematory or Facility Name 05/19/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held f-N Hold Address O d 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 or to Whom II.— 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 05/18/2020 Registrar of Vital Statistics (PamelaW GCoyf(ECectronicalrySiyned) /signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- Z Date of Disposition � 7© Place of Disposition ,,c W 2 (address) W cc N /section) (lot number) igra ve number) aName of Sexton or Person in Charge of Premises Z j ip! se print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) � - Receipt Human remains of delivered on , 20 ' r� Pine View Cemetery Repres-efifing the funeral home named on burial permit Official Funeral Directors Reg.or License# '