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Stevenson, Kristen Lyne
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kristen Lyne Stevenson Female Date of Death Age If Veteran of U.S.Armed Forces, 01/26/2021 33 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital • Manner of Death 0 Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Timothy Murphy Coroner Address 52 HAVILAND AVE,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 61 ©Burial Date Cemetery,Crematory or Facility Name 02/02/2021 Pine View Cemetery ❑Entombment Address EjCremation Queensbury Town,New York Donation 6 ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of t/) Transportation p 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 I- Remains are Shipped,If Other than Above ■� Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/29/2021 Registrar of Vital Statistics (piertf?ndim Curtis gkctronical5,Srwned) (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 2/7/7 0 21 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804 2 (address) W FriP. 30D 3 (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Connie Goedert (please print) uJ Signature 6rznux.. k. Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012840 Receipt \ j Human remains of delivered on - , 20 rr! it Pine Viev Cemetery Representhg efuneral home named on burial permit Official Funeral Directors Reg.or License# STEVENSON 11.1� NAME Kristen Stevenson Age. 33 Lot Owner: Heather Richards/ Alison Hezewski Lot# Erie 30D Grave# 3 Case: Concrete Died: 1 /2 6/2 0 21 Interred2/2/2 0 21 Funeral Home: Baker FH Cemetery: Pine View