Loading...
Brown, Helen NEW YORK STATE DEPARTMENT OF HEALTH ' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Heten Elizabeth Brown Female Date of Death Age If Veteran of U.S. Armed Forces, 01/21/2018 96 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address Westmount Health Facility Manner of Death Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 14 4©Burial Date Cemetery or Crematory 01/23/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold 0 Date Point of D. ❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address , ❑Reinterment Date Cemetery Address `y 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 Address 115 12" Permission is hereby granted to dispose of the human remains described above as indicated. MDate Issued 01/24/2018 Registrar of Vital Statistics Caroline71Bar6er(E(ectronica(IySigned) (signature) District Number 5657 Place Queensbury, New York Iw- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 1-2S/Y Place of Disposition r), eu r&,) Ccev►-iG-foi (address IZ (section) (lot number)/ (grave number) Name of Sexton or P 1 n in,Charge of Premises J� I i G-✓t v��^'ta-c4 "-- (please print) Signature /�"� `� Title C cO G- '� 76 (over) DOH-1555 (02/2004)