St. Onge, Deborah -- -- .M. Z1002/0)2
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NEW YORK STATE DEPARTMENT OF HEALTH Burial Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah Jean St.Cage Female
Date of Death Age if Veteran of U.S.Armed Forces,
07/11/2017 59 Yeare War or Dales
Place of Death Hospital, Institution or
City,Town or Village Glens Fans Street Address Glens Fells Hospital
Manner of Death frA
j Natural Cause 0 Accident 0 Homicide 0 Suicide Q Undetermined El Pending
Circumstances Investigation
•I Medical Certifier Name Title
Scott 9tasatn MD
Address
100 Park SI,Glens Falls,New York 12801
Death Certificate Flied District Number Register Number
City,Town or Village Glens Falls 5601 381
❑Burial Date Cemetery or Crematory
07/12/2017 • Pine View Crematory
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
n Removal and/or Held
• and/or
Address
�_ Hold
...r•
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home __ 01130
Address
11 Lafayette 81,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ti
Permission Is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/12/2017 Registrar of Vital Statistics or1•*A ask BIatrosicaar.ftiaaed
(signature)
District Number SB01 Place Glens Falls. New York
I certify that the remains of the decedent Identified above were disposed of In accordance with this permit on:
Date of Disposition 71 f3I fl Place of Disposition
(address)
77 (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Pr mises (iv
`pleas ►int)
Signature (14 Title ( 'nh
(over)
DOH-1555(02/2404)