Flynn, Carol NEW YORK STATE DEPARTMENT OF HEALTHU
Vital Records Section Burial - Transit Permit
-x. Name First Middle Last Sex
: Carol Flynn Female
Date of Death Age If Veteran of U.S. Armed Forces,
'iv; March 21,2016 87 War or Dates
Place of Death Hospital, InstitutiorW0rren Center For Rehabilitation And
City, Town or Village Queensbury Street Address N ursine
1Manner of Death I XI Natural Cause Accident ( Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier
1Name Title
Roslyn Socolof MD
Address
$:n:b 100 Broad St.,Glens Falls,NY 12801Death Certificate Filed District Number ster Number
c,ma
„.� City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
❑Entombment March 22,2016 Pine View Crematory
Address
1J Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
9 and/or Address
Hold
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0 Date Point of
N 1 i Transportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
''1 Permit Issued to Registration Number
„°` Name of Funeral Home Alexander-Baker Funeral Home 00035
", Address
e 3809 Main Street,Warrensburg,NY 12885
5. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
Permission is hereby granted to dispose of the human remains described ab as indicated.
4 = Date Issued 36_,J1 t .f, Registrar of Vital Statistics 1 0 v_-_ d ' ...C.A_-Q--s2.-e-N,c6kj
(signature)
" �J() T/O Queensbury,NY
.R�. District Number. Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 310/)L Place of Disposition 0?� . ��,„„ �
2 (address)
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pM (section) -(lot number (grave number)
Name of Sexton or Person in Charge of Premises n) y,‘,-
Z lease print)
W
Signature Title CalvArk
(over)
DOH-1555 (02/2004)