Reardon, Gaye NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
t Gaye Reardon Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/26/2018 57 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
fq Manner of Death Natural Cause El Accident 0 Homicide 0 Suicide EiUndetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
LL'0 John Quaresima MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed - District Number Register Number
City, Town or Village Glens Falls 5601 54
7, °'❑Burial Date Cemetery or Crematory
01/30/2018 Pine View Crematory.QEntombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal03 and/or Held
and/or Address
014. Hold
0 Date Point of
Q Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
tl�- 11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
g Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/30/2018 Registrar of Vital Statistics Ro6ertA Curtis(ECectronicalTy Signed)
(signature)
District Number 5601 Place Glens Falls, New York
6 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Date of Disposition ii 3a 1 i s;' Place of Disposition {Fu t., f�c,K fi---
Si (address)
t (section) J(lot number) ( (grave number)
Name of Sexton or Person in Charge of P mises `�` ) ' f
(pease print)
., Signature G�� Title /i'I9' .
(over)
DOH-1555 (02/2004)