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Tubbs, Marguerite `vtv r NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex ry Marguerite Mary Tubbs Female Date of Death Age If Veteran of U.S. Armed Forces, 47* 12/17/2018 94 Years War or Dates 44, 7,1 Place of Death Hospital, Institution or 1.1 City, Town or Village Queensbu Town Street Address Warren Center for Rehabilitation and Nursing Manner of Death ry Undetermined©Natural Cause O Accident O Homicide O Suicide Pending 1-4 Circumstances Investigation 4 Medical Certifier Name Title Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number R City, Town or Village Queensbury 5657 177 OBurial Date Cemetery or Crematory 12/20/2018 Pine View Crematory OEntombment Address ®Cremation Queensbury Town, New York Date Place Removed O Removal and/or Held and/or Address Hold Date Point of O Transportation Shipment by Common Destination Carrier O Disinterment Date Cemetery Address O 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 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/20/2018 Registrar of Vital Statistics Caroline J Bar6er(Efectronicaffy Signed) (signature) District Number 5657 Place Queensbury, New York 44, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ]a--?t-I? Place of Disposition (Prile GI-Li^-4- 4.br vr" (address) (section) (!ohnumber) (grave number) o• Name of Sexton or Person in Charge of Premises ,`L�4 I Prv✓u:llt n (please print)Signature l Title (over) DOH-1555 (02/2004)