Baker, Joe Ann ,1. • y ,Fj
NEW YORK STATE DEPARTMENT Or HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joe Ann L. Baker Female
Date of Death [ Age If Veteran of U.S. Armed Forces,
January 3,2012 68 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Bolton j Street Address 151 Alderbrook Road
Manner of Death EXI Natural Cause I I Accident I I Homicide Suicide I I Undetermined Pending
titCircumstances Investigation
O -
W Medical Certifier Name Title
0 Dr.Nancy Carney
Address
IHN,Wrg.,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Bolton 5650 I
❑Burial Date Cemetery or Crematory
El Entombment January 4,2012 Pine View Crematory
Address
❑x Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
ZZ I 'Removal I and/or Held
and/or Address
F Hold
Cl)
O Date Point of
NI I Transportation i Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home I 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped, If Other than Above
2 Address
CZ
a
Permission is hereby granted to dispose of the human remains described a ove indicated.
ndicated.
Date Issued I-1 a o 1 . Registrar of Vital Statistics _ gyp
(signature)
District Number 5650 Place Bolton
I certify that the remains of the decedent identified above were disp d of in accordance with this permit on:
W Date of Disposition I- - IL Place of Disposition a nt U tti.a
2 (address)
W
(section) (lot number) (grave number)
• Name of Sexton or P rson in Charg of Premises
Z (please print)
W /
Signature ,"�� Title COX UV1 Sri�,
(over)
DOH-1555 (02/2004)