Baird, Debra NEW YORK STATE DEPARTMENT OF HEALTH 0 Vital Records Section Burial - Transit Permit
iiiiiii Name First Middle Last Sex
:i .. Debra D. Baird Female
': f Date of Death Age If Veteran of U.S. Armed Forces,
:e::• March 8,2014 60 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
r.; Manner of Death i Xi Natural Cause I ]Accident Homicide Suicide Undetermined Pending
:. Circumstances Investigation
Medical Certifier Name Title
is Narredl Siddiqui Dr.
: r, Address
K:• 100 Park Street,Glens Falls,NY 12801
::.: Death Certificate Filed District Numbe5601 Register Number
iii?
City, Town or Village Glens Falls 1 1 7
❑Burial Date Cemetery or Crematory
March I°?, 2014 Pine View Crematorium
❑Entombment - Address
11 Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ• n Removal and/or Held
and/or Address
▪ Hold
Cl)
O Date Point of
u) Transportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
r ( Permit Issued to Registration Number
:i:;: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
E*:: Address
;f::: 53 Quaker Road,Queensbury,NY 12804
;:;:; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r ' Permission is hereby granted to dispose of the human remains described above as indicated.
s�;:;: Date Issued 3 /t 2 1 I I/ Registrar of Vital Statistics h) C I r W✓~��{:: (sign ure)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z p 3r/� � � ,,A '
W Date of Disposition I Place of Disposition 2cJia � (address)
W.
CO A
rt +1, (section) (lot number) (grave number)
gName of Sexton or erso . Ch f Premises
Z (pl9ase print)
Signature 0 / j� Title (�Z� y'` �`
(over)
DOH-1555(02/2004)