Tresten, Adele Loretta ,. . # g
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Adele Loretta Tresten Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2021 76 Years War or Dates
F. Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 8 Margaret Drive, Queensbury Town, New York 12804
pManner of Death Natural Cause ❑Accident 0 Homicide Suicide 0 Undetermined ❑Pending
Circumstances Investigation
G• Medical Certifier Name Title
Aimee Mcmaster Nurse Practitioner,Acute Care
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 13
0 Burial Date Cemetery,Crematory or Facility Name
01/14/2021 Pine View Crematory
0 Entombment Address
gCremation Queensbury Town,New York
ElDonation
O• ElRemoval Date Place Removed
H and/or and/or Held
Hold Address
O
a. Date Point of
Cl) ❑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
H. Remains are Shipped,If Other than Above
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/14/2021 Registrar of Vital Statistics Camline9(l%egari Barher(EYectronicalySigned)
(signature)
District Number 5657 Place Queensbury, 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 M.,07,2/ Place of Disposition 6ni ,, (,� Creucer
4
LU
(add
W
CC
N (section) (lot num er) (grave number)
0 Name of Sexton or Person in Charge Premises Tot/MLA E, LtJ00
Z I (please print)
W Signature �` Title (please
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 414
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ! ,