Dean, Muriel 4 4 't 'C j
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Muriel Dean Female
Date of Death Age If Veteran of U.S. Armed Forces,
01/1112011 96 years War or Dates
I- Place of Death Hospital, Institution or
City, To�pt9 *, Glens Falls Street Address
0 Manner o ea 1 atural Cause Accident Homicide Suicide Undetermined Pending
lJ Circumstances Investigation
iLt Medical Certifier Name Title
William Tedesco M.. R
Address
3 Irongate Center Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
`> City, TclidivAtIly Glens Faits 56n1 14
"'' ❑Burial Date Cemetery or Crematory
f ;; ['Entombment 01/12/2011 Pine View Crematorium
Address
Rii Rpremation Qiieensbury, NY 12804
Date Place Removed
?� ❑Removal and/or Held
C and/or
Address
Cl) Hold
O Date Point of
EZ` Trans ortation
❑ p Shipment
0 by Common Destination
Carrier
Q Disinterment Date. Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
>_ Name of Funeral Home Maynard D. Baker Funeral Home 01149
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
re
iti
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/12/2011 Registrar of Vital Statistics LA.)Gu --- t,\)..&"
(signatu )
<s District Number Place
5601 Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
if Date of Disposition .ic,., (''► zei Place of Disposition -P 4(Ui$„ C,.t,,,hsfidr,,,r•-
(address)
in
U,
CC (section) n - (lot numbely (grave number)
C � S its Name of Sexton or Pe on in Charg f Premises r.�\ ✓ t*A..t[f
2 (please print)
10. Signature lrL Title (1%?-VI a
(• (over)
DOH-1555 (02/2004)