Ransom, Virginia Lynne #1136
10.
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Virginia Lynne Ransom Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/07/2020 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
'p▪ Manner of Death Natural Cause Accident Ei Homicide Suicide Undetermined El Pending
V Circumstances Investigation
W Medical Certifier Name Title
CI Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 475
❑Burial Date Cemetery,Crematory or Facility Name
10/19/2020 Pine View Crematory
ElEntombment Address
X❑Cremation Queensbury Town,New York
ElDonation
0 Removal Date Place Removed
and/or and/or Held
CO Hold Address
0
0. 1-1 Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
5 Address
Ili
IW
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/19/2020 Registrar of Vital Statistics tp6ertf7n1reuiCurns(Electivnical6y5Wne'2
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /0/20/Zo Place of Disposition CU
�/
2 (address)
lilt
(I)
CC (section) (lot number) (grave number)
S Name of Sexton or Person in Charge of Premises d
t. .�
Z ()lease print) /"
W Signature �:/ Title ( *etiA't
DOH-1555(o7/18)p i of 2
• Public Health Law Sec. 4145(2b) 014126
Receipt
Human remains of delivered on , 20 •
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#