Loading...
Maxam, Helen NEW YORK STATE DEPARTMENT OF I-(EALTH Vital Records Section • 4 Burial - Transit Permit E• Name First Middle Last Sex ',,,, Helen Maxam Female Date of Death Age If Veteran of U.S. Armed Forces, 05/30/2018 80 Years War or Dates _ a Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital ' Manner of Death©Natural Cause El Accident ID Homicide D Suicide ri Undetermined n Pending r Circumstances Investigation Medical Certifier Name Title -+ William Cleaver MD Address A Cr Park St,Glens Falls,New York 12801 ; Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 272 ry '❑Burial Date Cemetery or Crematory 1,77 05/31/2018 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury, New York Date Place Removed • Removal and/or Held . and/or Address Hold ,, Date Point of • ❑Transportation Shipment by Common Destination Si Carrier ❑Disinterment Date Cemetery Address • ❑Renterment Date Cemetery Address Permit Issued to Registration Number O. Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address • 9 Pine St,Chestertown,New York 12817 , 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 05/31/2018 Registrar of Vital Statistics Wp6ertA Curtis(E(ectronica((y Signed) (signature) District Number 5601 Place Glens Falls, New York 71 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ., Date of Disposition (j/i 0 Place of Disposition ?NIL, � a-- (address) 41 , (section) (lot/Lumber) (grave number) F Name of Sexton or Person in Charge of Premises # (pleas nt) Signature L-� Title 01^4Ij1Yt (over) DOH-1555(02/2004)