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O'Sullivan, Maureen Sharon NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Maureen Sharon O'Sullivan Female Date of Death Age If Veteran of U.S.Armed Forces, 10/07/2020 53 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 14 Victory Court,Warrensburg Town, New York 12885 W Manner of Death Undetermined 1=1Pending � © Natural Cause �Accident �Homicide �Suicide Circumstances Investigation W Medical Certifier Name Title 0 John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 24 Burial Date Cemetery,Crematory or Facility Name 10/09/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation OZ Removal Date Place Removed and/or and/or Held t Hold Address an 0 a 1-1 Date Point of U) ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/08/2020 Registrar of Vital Statistics Pamela M Lloyd(Electronically Signed) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �/ Z Date of Disposition /04 120 Place of Disposition , it. r,,- 2 (address) W (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premises !A (p ase Brio W Signature Title L lifoN`K DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 01, 0, Receipt Human remains of delivered on , 20 } Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# f