Daly, Catherine • 3 '
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Catherine Daly Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/25/2020 60 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death
Ei Natural Cause 0 Accident 0 Homicide El Suicide El Undetermined Pending
V Circumstances Investigation
ILIQ Medical Certifier Name Title
Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 597
❑Burial Date Cemetery,Crematory or Facility Name
12/29/2020 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
Donation
ZO 0 Removal Date Place Removed
and/or and/or Held
F-N Hold Address
0
O. Date Point of
(/) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/29/2020 Registrar of Vital Statistics YP6ertAufrrxWCut c(ElectronicalySigned)
(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:
IF-
Z Date of Disposition /2 �- Place of Disposition / i.1 i UTQ yst 4, ,i�
2 (address/
W
(/)
CC (section) 1 /((otnumber) (grave number)
Name of Sexton or Perso Charge of Premises _.. tu. /! r i ((96�L�+
Z
(please print)
LU Signature2 Title � �" �r'
DOH-1555(07/18)pi 0 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#