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Smith, Constance ,_ • ..,„ 11 1 f 7 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Constance Joy Smith Female Date of Death Age If Veteran of U.S.Armed Forces, 10/30/2018 66 Years War or Dates • Place of Death Hospital, Institution or fi City, Town or Village Glens Falls Street Address Glens Falls Hospital gym" Manner of Death Undetermined Pending g' ©Natural Cause �Accident �Homicide �Suicide � � Circumstances Investigation Medical Certifier Name Title Jean Vanauken PA Address r 100 Park St,Glens Falls,New York 12801 - Death Certificate Filed District Number Register Number City, ty, Town or Village Glens Falls 5601 511 ❑Burial Date Cemetery or Crematory 10/31/2018 Pine View Crematory ❑Entombment Address • ®Cremation Queensbury Town, New York NA- Date Place Removed • ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment • by Common Destination Carrier Disinterment Date Cemetery Address ' Date Cemetery Address ❑Reinterment Permit Issued to Registration Number ,- Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 1 Name of Funeral Firm Making Disposition or to Whom , Remains are Shipped, If Other than Above • Address `• i Permission is hereby granted to dispose of the human remains described above as indicated. • Date Issued 10/31/2018 Registrar of Vital Statistics R96ertA Curtis(ECectronicatfySigned) (signature) Y District Number Place 5601 Glens Falls, New York ;4ii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ` _r Date of Disposition it 1 t jI S Place of Disposition call{,,,, 40,—, (address) (section) (lot numb (grave number) ' Name of Sexton or Person in Charge of Premises w1ji iI. PIJi =" (please print) ; Signature (w1 k Title _ (over) DOH-1555 (02/2004)