Palmer, LindaIF 6 Z-1
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last
Sex
Female
Linda Geneva Palmer
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/19/2019
1 71 Years
War or Dates
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Place of Death Hospital, Institution or
Street Address The Pines At Glens Falls Center For Nursing &Rehabilitation
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W
City, Town or Village Glens Falls
Manner of Death 1:1Undetermined ❑ Pending
� Natural Cause Accident Homicide SuicideEl
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Circumstances Investigation
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Medical Certifier Name Title
0
Jean Flanagan MD
Address
170 Warren St, Glens Falls, New York 12801
Death Certificate Filed
District Number
Register Number
City, Town or Village Glens Falls
5601
414
Burial
Date Cemetery, Crematory or Facility Name
Entombment
09/24/2019 Pine View Crematory
Address
Cremation
Queensbury Town, New York
Donation
❑ Removal
Date
Place Removed
0
and/or Held
and/or
}-
Hold Address
1iA
dDate
Point of
N
Transportation Shipment
p
by Common
Carrier
Destination
Disinterment
Date
Cemetery Address
El Reinterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home Maynard D Baker Funeral Home
01130
Address
11 Lafayette St, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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W
a'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/24/2019 Registrar of Vital Statistics WpAertlndrewCurtz+ (E&trvnicaleySigne4
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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W
Date of Disposition 1171119 Place of Disposition �✓ �i� f�a�"
(address)
2
W
N
(section) lot number) - (grave number)
Name of Sexton or Person in Charge of Premises r, a 1`"
(p!e e print)
W
Title
'
Signature
DOH-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
. V
012553
Receipt
Human remains of
Pine View Cemetery
Official
delivered on
-, 20_
t.
Representing the funeral home named on burial permit
Funeral Directors Reg. orLlicense #