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Hammond, Carol NEW YORK STATE DEPARTMENT OF HEALTH � Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol Jane Hammond Female Date of Death Age If Veteran of U.S.Armed Forces, 11/15/2020 72 Years War or Dates �.. Place of Death Hospital,Institution or Z City,Town or Village Chester Town Warren Street Address 7797 State Route 9,Chester Town Warren,New York 12860 p Manner of Death © Natural Cause Accident 0 Homicide 0 Suicide ❑Undetermined ❑Pending O Circumstances Investigation O Medical Certifier Name Title Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed District Number Register Number City,Town or Village Chestertown 5652 13 ❑Burial Date Cemetery,Crematory or Facility Name 11/17/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York ❑Donation O• ElRemoval Date Place Removed and/or and/or Held Hold Address 0 V) Transportation Date Point of p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2020 Registrar of Vital Statistics Mindy Conway(ECectronica1Ty Signed) (signature) District Number 5652 Place Chestertown, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ �T` Z Date of Disposition n i0 Place of Disposition W (ad res)� W N CC (section) Jot number) (grave number) 0a Name of Sexton or Person in Char of Premises r�� U � Z (pleas*print) lL Signature Title *Apt DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 1.4 2 f 5 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1