Warren, Joann 46i
NEW YORK STATE DEPARTMENT OF HEALTH . ITVital Records Section ` - ,Burial - Transit Permit
Name First Middle Last Sex
Joann Eleanor Warren Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/17/2018 85 Years War or Dates
Place of Death Hospital, Institution or
= City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death zurzgl Natural Cause Accident El Homicide 0 Suicide El Undetermined El Pending
� Circumstances Investigation
Medical Certifier Name Title
-` Courtney Stewart NP
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
• City, Town or Village Glens Falls 5601 397
-? Date Cemetery or Crematory
❑Burial
08/21/2018 Pine View Crematory
Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal
�- * and/or Held
- `= and/or Address
• Hold
Date Point of
Q Transportation Shipment
,.° by Common Destination
Carrier
p Q Disinterment Date Cemetery Address
•4 [�Reinterment Date Cemetery Address
f'
y t 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
-t=! Address
Permission is hereby granted to dispose of the human remains described above as indicated.
- Date Issued 08/20/2018 Registrar of Vital Statistics 44)6ert A Curtis(E&ctronica1Cy Signed)
(signature)
District Number 5601 Place Glens Fails, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition g -,L1-)$) Place of Disposition p;N,R, Vi r,W c r ,,c ocy
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Tesm,t/ Ste,('-t,S
(please print)
Signatur / ,, e$` Title C�� i
.•�� " (over)
DOH-1555 (02/2004)