Morgan, Carole NEW YORK STATE DEPARTMENT OF HEALTH Z w • 4 w
Vital Records Section Burial - Transit Permit
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stances Imrestigatim
Medcal Certithar Name d Tie
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Date Place Removed ' l.9,-.
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• Hold
Date Point of
• 0 Transportation Shipment
• by Corrnrwn Destination
• Carrier
'"[]Disinterment Date Cemetery Address
Date Cemetery Address
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Remterrnent
!› Penal Issued to Member
Name of Funeral Home Maynard D. Baker Funeral Home ()7/V g
r,L Address 11 Lafayette Street
Queensbury, New York 12$(11
Name of Funeral Firm Making Disposition or to Whom
Renabs are Shipped, If Other than Above
Address
Permission is hereby granted to depose of the human remains described above as mod.
Date Issued 01 / i / 1 1 Registrar of V tal Stedistics t ) C-xr k•‘.'_,/- 4-'
District Number 51 a I Place 6 S t 1 s K)
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I certify that the remains of the decedent identified above were deposed of in accordance with this permit on:
• Date of Disposition 4kt.)%I 1 xi( Place of Disposition P,wc U,t k-J Crdm.rt- ,44h,
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Title CP rh KIT012
(over)
DOH-1555 (02/2004)