Younes, Sara NEW YORK STATE DEPARTMENT OF HEALTH , R ?iv
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
PiSara Elizabeth Younes Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/13/2017 66 Years War or Dates
`. Place of Death Hospital, Institution or
cil City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death rtrej Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending
' Circumstances Investigation
NY Medical Certifier Name Title
Paul Bachman MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
-fin
City, Town or Village Glens Falls 5601 534
Date Cemetery or Crematory
❑°� Burial
%„ 10/16/2017 Pine View Crematory
❑Entombment Address
A ®Cremation Queensbury Town, New York
Oil Date Place Removed
❑Removal and/or Held
,74
and/or Address
Hold
Date Point of
tal
❑Transportation Shipment
by Common Destination
Carrier
- ❑Disinterment Date Cemetery Address
itti
❑Reinterment Date Cemetery Address
r Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
ri
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
{.....a Address
E
41 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/16/2017 Registrar of Vital Statistics 4Zg6ertACurtis Ekctroauaaysig+ed'
(signature)
" District Number Place
q- 5601 Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i
Date of Disposition fv 1lg 111 Place of Disposition ? uI.,- /�'orlw^
el
(address)
rtl} (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premise 1�*.rt - jo 14rL
(pl�t se print)
Tr
/4
Signature Title TR hilift-
(over)
DOH-1555 (02/2004)