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Gerrard, Carolyn f - ' 476 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Carolyn Rose Gerrard Female Date of Death Age If Veteran of U.S.Armed Forces, 06/08/2018 82 Years War or Dates Place of Death Hospital, Institution or • City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause El Accident Homicide El Suicide El Undetermined n Pending Circumstances Investigation Medical Certifier Name Title Gamal Khalifa MO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 292 ❑Burial Date Cemetery or Crematory 06/14/2018 Pine View Crematory ❑Entombment Address NCremation Queensbury Town, New York Date Place Removed ri Removal and/or Held and/or Address I*" Hold Date Point of Q Transportation Shipment by Common Destination Carrier ID 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 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/12/2018 Registrar of Vital Statistics RobertA Curtis.('ECectronicat2ySigned) (signature) District Number 5601 Place Glens Falls, New York tt I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition t iNial Place of Disposition , � 1 o i_' (address) (section) ( (lot number) (grave number) ` Name of Sexton or Person in Charge of Premises r1i+i' J$t,,+14 (please print) ti Signature (.n Title 1(40tri.k. (over) DOH-1555 (02/2004)