Rhodes, Sally N. IOo6
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sally Ann Rhodes Female
E Date of Death Age If Veteran of U.S. Armed Forces,
12/26/2017 79 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ci Natural Cause 0 Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending
Circumstances Investigation
to Medical Certifier Name Title
CI
Wendy Steinhacker PA
fci. Address
100 Park St,Glens Falls,New York 12801
I Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 677
0 Burial Date Cemetery or Crematory
12/28/2017 Pine View Crematory
. ❑Entombment' Address
®Cremation Queensbury Town, New York
Vkt Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
1❑Transportation Shipment
ES 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
i . Address
yTM 11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
p
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
to Date Issued 12/28/2017 Registrar of Vital Statistics NRcbertACurts EfectronicufySigned
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance withitP this permit on:
Date of Disposition I` Z f I$ Place of Disposition FINAL-
(address)(address)
(section) (lot umber) (grave number)
Name of Sexton or Person in harge of Premise •,j �rft
( ease tint)
Signature / Title 74-
(over)
DOH-1555 (02/2004)