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Collard, Hilda Fay NEW YORKSTATE DEPARTMENT OF HEALTH a Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex y Hilda Fay Collard Female Date of Death Age If Veteran of U.S.Armed Forces, _' 12/31/2020 80 Years War or Dates r.,; Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending UCircumstances Investigation W Medical Certifier Name Title 0 William Cleaver MD Address -, 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number ,', City,Town or Village Glens Falls 5601 611 r Burial Date Cemetery,Crematory or Facility Name 01/04/2021 Pine View Crematory P ❑Entombment Address ti, Cremation Queensbury Town,New York . '',_- ❑Donation ZRemoval Date Place Removed and/or and/or Held E,- Hold Address N 0 a Date Point of U) Li Transportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address �. ❑Reinterment Date Cemetery Address x 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 p- Remains are Shipped,If Other than Above 2 Address CC W q Permission is hereby granted to dispose of the human remains described above as indicated. v Date Issued 01/04/2021 Registrar of Vital Statistics Men Andrew Curtis(E(ectronicalCySigned) (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 1/(p 121 Place of Disposition ?..ILZial it, al 2 (address) W NCC (section/ / (lot number) I (grave number) Name of Sexton or Person in Charge of Premises 1 r,, L A 411 (p/e se print) Z ILI- Signature Title ` �"�r"�� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01437,5 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the.funeral home named on burial permit Official Funeral Directors Reg.or License#