Russell, Esther Louise NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital.Records
Name First Middle Last Sex
Esther Louise Russell Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/27/2020 97 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
UJ
W Manner of Death 0 Natural Cause Accident 12:1Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Jennifer Donovan DO
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 595
0 Burial Date Cemetery,Crematory or Facility Name
12/29/2020 Pine View Crematory
QEntombment Address
0 Cremation Queensbury Town,New York
ElDonation
0 Removal Date Place Removed
and/or and/or Held
to Hold Address
0
�- Date Point of
N ❑Transportation
by Common Shipment
Carrier Destination
❑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
5 Address
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/28/2020 Registrar of Vital Statistics Yetr6ertf7ndirw Curtis(Electronicalf5Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition r2-Z9-20"u) Place of Disposition j?ihku tied
IJJddressJ
W
re N (section) \ (lot number) (grave number)
G Name of Sexton or Person' C2o! remisesrge PL
'' � r�_�(please print)
W Signature Title Gt r6 ry !y Q �'�
DOH-1555(07/18)p 1 of
Public Health Law Sec. 4145(2b) 1 4 3 7
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#