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McCarty, Helen E.
1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen E.McCarty Female Date of Death Age If Veteran of U.S.Armed Forces, 01/07/2021 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address 1871 Garnet Lake N Road,Johnsburg Town,New York 12843 W Manner of Death Pending � © Natural Cause �Accident Homicide Suicide �Undetermined � W Circumstances Investigation WMedical Certifier Name Title O Mary Stein NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 1 ElBurial Date Cemetery,Crematory or Facility Name 01/09/2021 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ElDonation ZO El Removal Date Place Removed and/or and/or Held i- Hold Address tJi 0 a. Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination Disinterment 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 it Remains are Shipped,If Other than Above 2 Address W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2021 Registrar of Vital Statistics tk(een C.Lorah(ECectronically Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition /i n/7I Place of Disposition" address) rpliOr W CC CC (section) n i (lot number (grave number) g Name of Sexton or Person in Charge of r mises Q (pie se print) Z 1 1 W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 4 4 n 0 Receipt Human remains of delivered on i , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#