Pece, Kelly Ann ft 1075
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kelly Ann Pece Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/29/2020 55 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 24B Columbia Avenue,Glens Falls,New York 12801
pManner of Death �Natural Cause 0 Accident El Homicide 0 Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
W Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 HAVILAND AVE,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 444
ElBurial Date Cemetery,Crematory or Facility Name
10/02/2020 Pine View Crematory
Entombment Address
gCremation Queensbury Town,New York
ElDonation
0 ❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
O
�. Date Point of
CO Li Transportation Shipment
O by Common
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
1— Remains are Shipped,If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/02/2020 Registrar of Vital Statistics Rp6er7/lndrewCurtis(E/ctronicaf Srgnea)
(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:
Z Date of Disposition '0/2,J 10 Place of Disposition 'Flu Vt.,, 404."""
UJ
(address)
W
Q (section) (lot number) (grave number)
(f)
8 Name of Sexton or Person in Charge of remises a f SIAAAIlt
Z Ouse print) fizt,�,�y�
IU Signature / r Title "'ll"'�
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 014067
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#