Baker, Nancy NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section a Burial - Transit Permit
Name First Middle Last Sex
Nancy SeMia Baker Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 5,2018 73 War or Dates
Place of Death Hospital, Institution or
°Z City, Town or Village Saratoga Springs Street Address Mary's Haven
LLI
Manner of Death (Xi Natural Cause I I Accident Homicide Suicide Undetermined Pending
111 Circumstances Investigation
W Medical Certifier Name Title
a Ageel A. Gillani MD
Address
102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Numb r
City, Town or Village Saratoga Springs 4501 7. L.j 7
❑Burial Date Cemetery or Crematory
— Entombment May 10,2018 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
F_- Hold
O Date Point of
u) Transportation Shipment
a by Common Destination
Carrier
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 Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I Remains are Shipped, If Other than Above
2 Address
LL
al
0.
Permission is hereby granted to dispose of the human remai cri d at as indicated.
(signature)
Date Issued 5-8-18 Registrar of Vital Statistics "1. —4-ritztirvA
(signature)
District Number 4501 Place Saratoga Springs,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition Place of Disposition
W (address)
CL
(section) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises
Z (please print)
W
Signature Title
(over)
DOH-1555 (02/2004)