Baker, Mary �_ . , li lag
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary M Baker Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/20/2018 97 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide ElUndetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Abigail Macomber PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Villa e Glens Falls 5601 248
[]Burial Date Cemetery or Crematory
05/22/2018 Pine View Crematory
Entombment
-------- - -----
Address
j®Cremation Queensbury Town, New York
Date Place Removed
6 ri Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
L by Common Destination
- Carrier
Q Disinterment Date Cemetery Address
,, Date Cemetery Address
❑Renterment
Permit Issued to Registration Number
.. Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
- Address
136 Main St,S Glens Falls,New York 12803
g Name of Funeral Firm Making Disposition or to Whom
I.* Remains are Shipped, If Other than Above
Address
CC
ILI
OL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/21/2018 Registrar of Vital Statistics Robert Curtis(ECectronicaffySigned)
(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:
W Date of Disposition 51;5jir4 Place of Disposition fv�.r &4o..
(address)
(section) (lot number)c (grave number)
▪ Name of Sexton or Person in Char of Premises At - .J4"""'
z
d ( ase print)
La Signature Title AzP0 0`2
r (over)
DOH-1555(02/2004)