Snyder, Carly M. ._ a :tt /b gb
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carly M.Snyder ! Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/03/2020 29 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
� � Natural Cause �Accident �Homicide �Suicide
!L
U Circumstances Investigation
al Medical Certifier Name Title
O Paul Bachman - MD
Address
3767 Main Street,Warrensburg Town,New York 12885
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 453
❑ Burial Date Cemetery,Crematory or Facility Name
10/07/2020 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
Donation
ZZ• Removal Date Place Removed
- and/or and/or Held
~- Hold Address
N
0
a. Date Point of
N Transportation Shipment
$ by Common
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
1— Remains are Shipped,If Other than Above
M Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/06/2020 Registrar of Vital Statistics IppbertAndrew Curtis('Electronically Signed)
(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:
Ir
Z Date of Disposition /0 11 Ito Place of Disposition FtU+w f•-_.
2 (address)
W
N (section) of number) (grave number)
0 1tif.� �_ _5;4v
• Name of Sexton or Person in Charge of Pre ' es
Z (pleas print)
W Signature Title !matt{
ICC
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 1.4 0 1
Receipt
Human remains of i delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#