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Baker, Shirley IN NEW YORK STATE DEPARTMENT OF HEALTH t- At ' 1 Vital Records Section Burial - Transit Permit I Name First Middle Last Sex Shirley Catherine Baker Female Date of Death Age If Veteran of U.S. Armed Forces, June 2, 2014 90 War or Dates I— Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital CI Manner of Death© Natural Cause El Accident El Homicide El Suicide 0Undetermined n Pending 0til Circumstances Investigation WW Medical Certifier Name Title James North Address 100 Broad St. Glens Falls, New York 12801 Death Certificate Filed District Number Register Numb r City, Town or Village 5 / A-; Burial Date Cemetery or Crematory / June 4, 2014 Pine View Crematorium ❑Entombment Address ECremation Quaker Road Queensbury,NY 12804 Date Place Removed zriRemoval and/or Held 0 and/or Address p Hold IA Date Point of C? Transportation�. ElP Shipment t!? by Common Destination ID Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00281 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom { Remains are Shipped, If Other than Above 2'; Address W Ci.. Permission is hereby ranted to dispose of the human rains d cribed abo e as indica d. Date Issued ' G Registrar of Vital Statistics I' � Q2l"-e—,. (sure) 2. District NumberILoO Place � �� �. J F- I certify that the remains of the decedent identified above were isposed of in accordant with this permit on: W' Date of Disposition 06/04/2014 Place of Disposition Quaker Road Queensbury,NY 12804 M' (address) W (1) r (section) j (lot number) r, (grave number) 0 Name of Sexton or Per on in Charge of Premises GFfosfi4, 34 Z' � (please print) W Signature ci1`' Title a2 Y02 (over) DOH-1555 (02/2004)