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Baker, Patricia R 'Iit. ° NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit e Name First Middle Last Sex Patricia R. Baker Female a Date of Death Age I If Veteran of U.S. Armed Forces, January 26,2016 85 I War or Dates Place of Death Hospital, Institution or Ii: City, Town or Village Glens Falls Street Address Glens Falls Hospital Mann r° e ofDeath �Natural Cause Accident Homicide Suicide I I Undetermined Pending iti; Circumstances Investigation w Medical Certifier Name Title ai Daniel Way _ R�� Address HHHN,North Creek,NY 12853 . , Death Certificate Filed Distic.:t Number S` i^� Register Number ? City, Town or Village C / 5 , ❑Burial Date Cemetery or Crematory El Entombment February 1,2016 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold Cl) 0 Date Point of N1-1 L .risportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address pi Reinterment Date Cemetery Address Permit Issued to Registration Number " Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 :' Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped, If Other than Above Address Iii `"° Permission is hereby granted to dispose of the human remains described above as indicated. N Date Issued J/ 2 F//6 Registrar of Vital Statistics LA) A_llyY,-rit �1! (sign ture) District Number 5 0 / Place l `SFek05, i' > I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 1_/ L//(, Place of Disposition � (,,..) 4tori„... W (address) co 0 (section) // (lot npmber) (grave number) ra Name of Sexton or Person in Char of Premises ��r,l „ e„nib Z as' / (please print) Signature /L�"i� _ Title (tterP(1 (over) DOH-1555 (02/2004)