Cole, Maxine Lurene 11
(3b
NEW YORK STATE DEPARTMENT OF HEALTH Bu
rial of Vital Records - Transit Permit
Name First Middle Last Sex
Maxine Lurene Cole Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2021 84 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Easton Town Street Address 204 Herrington Hill Road, Easton Town,New York 12834
p Manner of Death 0 Natural Cause El Accident ❑Homicide ❑Suicide 0 Undetermined 0 Pending
W
U Circumstances Investigation
Q Medical Certifier Name Title
Matthew Pender MD
Address
35 Gilbert Street,Cambridge Village,New York 12816
Death Certificate Filed District Number Register Number
City,Town or Village Greenwich 5753 2
0 Burial Date Cemetery,Crematory or Facility Name
02/05/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
ZZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
d Date Point of
(/) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped,If Other than Above
Address
Ix
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/04/2021 Registrar of Vital Statistics fM'egltan 2'ltakn(Electronicaf Signed)
(signature)
District Number 5753 Place Greenwich, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition a,6—ap,7( Place of Disposition Pi ,)e u v eid e f- 4•-0 t-)
W
2 (address)
W
cn
cc 7 (section) �f E.
numr) (grave number)
gName of Sexton or Person in Charge Premises �j�7 /YIU�� G LVw�
Z (please print)
Ill Signature ���a ' Title ( 4._PL`
DOH-1555(07/18)p 1 of 2
li
Public Health Law Sec. 4145(2b) 01 II 502 1
Receipt
rl 1
Human remains of - \ delivered on r , 20
1
,/.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# 1