Steves, Judith NEW YORK STATE DEPARTMENT OF HEALTH~ 4 6 3
Vital Records Section Burial - Transit Permit
` Name First Middle Last Sex
Judith Marie Steves Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/13/2018 72 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death v5jrzgl Natural Cause ❑Accident ElHomicide ❑Suicide ❑ Undetermined ❑Pending
;; Circumstances Investigation
ui Medical Certifier Name Title
Shahid Ahmed MD
i
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 27
❑Burial Date Cemetery or Crematory
01/18/2018 Pine View Crematory
El Entombment Address
- ®Cremation Queensbury Town, New York
l Date Place Removed
3❑Removal and/or Held
and/or Address
Hold
Date - Point of
Transportation Shipment
❑
by Common Destination
Carrier
^ yy❑Disinterment Date Cemetery Address
❑Renterment
1Date Cemetery Address
Permit Issued to Registration Number
`s 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
t. Remains are Shipped, If Other than Above
Address
-" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/17/2018 Registrar of Vital Statistics co6ertA Curtis(ECectronicalfySigned)
(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:
Date of Disposition l -/9 Place of Disposition ?Th Q-V;�.,j e�rrt.r_ :if
(address)
0
04 (section) (lot numb r) (grave number)
aName of Sexton or P n ' harge of Premises - .l L 1 ram.-1 6 it._ 4-/-e.
Z. (please print)
Signature Title Gce_ �+?� e-
(over)
DOH-1555 (02/2004)