Hanna, Julia NEW YORKSTATE DEPARTMENT OF HEALTH ,,w: 4 Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Julia Hanna Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/03/2020 72 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
UI Manner of Death Q Natural Cause Accident 0 Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
W Medical Certifier Name Title
0 Jean Flanagan MD
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 187
ElBurial Date Cemetery,Crematory or Facility Name
10/06/2020 Pine View Crematory
EiEntombment Address
0 Cremation Queensbury Town,New York
EiDonation
0 Removal Date Place Removed
and/or and/or Held
CD Hold Address
0
i . Date Point of
N Li Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
—. Remains are Shipped,If Other than Above
2 Address
LE
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/05/2020 Registrar of Vital Statistics Carolinexkregare Bar6er(E/ctronicalySigned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ZZ Date of Disposition )0 b I jQ Place of Disposition i,�,it.,_ fx.......-
tu
2 (address)
W
N (section) (lot number) (grave number)
Qs
gName of Sexton or Person in Charge of Pre L �'� number).._____ (grave
Z (pl se print)
W 6�' 14 t Z
Signature Title
DOH-1555(o7/t8)pi of 2
Public Health Law Sec. 4145(2b) 0140 12
Receipt
Human remains of delivered on , 20
I
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#