Germain, InaNEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
Name First
Ina June Germain
Date of Death Age
10/24/2019 88 Years
.: Place of Death
City Town o V'll
6
Middle
Last
If Veteran of U.S. Armed Forces,
War or Dates
W
r age Granville Town
Manner of Death
W ®Natu
U ral Cause Accident
hi Medical Certifier93 Name
Robert Love
d3 Irongate Center, Glens Falls, New sYork 12801
Death Certificate Filed
Burial - Transit Permit
Sex
Female
Hospital, Institution or
Street Address Hanes House of Hope
Homicide Suicide Undetermined
Pending
Circumstances Title Investigi
MD
City, Town or Village Granville District Number
5756
Burial Date Cemetery, Crematory or Facility Name
Entombment 10/29/2019 Pine View Crematory1:1 Address
lnJ Cremation Queensbury Town, New York
Donation
= ate
� n Removal DPlace Removed
and/or and (or Held
Hold I Address
Transportation Date Point of
by Common Shipmei
Carrier Destination
❑ Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to
Name of Funeral Home Alexander Baker Funeral Home
Address
3809 Main St, Nfarrerrsburg, New York 12885
Name of FUne4finn Making Disposition or to Whom
Fremains ere shipped, If Other than Above
Address
Register Number
87
Registration Number
00037
Permission Is hereby granted to dispose of the human remains described above as indicated.
Dale issued i012912019 Registrar of Vital Statistics ,fenny Linda 912artelle (Electronically Signed)
District Number 5756 Place Granville, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 10 j Place of Disposition P , -a, j
(grave
e of f�nises r! 4lr H4.,r 0,
Name of Sexton or Person in Charge ' (please Out)
Title C /L= ��' ✓i
Signature
DOH-15� 5P1of2
Public Health Law Sec. 4145(2b) -L 3 0 3 s
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License # "yam