Houlihan, Megan Anne It /5Z
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Megan Anne Houlihan Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/12/2021 61 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 110 Sagamore Street 4C, Glens Falls, New York 12801
p Manner of Death gi Natural Cause El Accident 1=1 Homicide El Suicide 0 Undetermined 0 Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Patricia Stevenson PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 101
ElBurial Date Cemetery,Crematory or Facility Name
02/17/2021 Pine View Crematory
ElEntombment Address
ElCremation Queensbury Town,New York
El Donation
ZEl
Removal Date Place Removed
O and/or and/or Held
1- Hold Address
N
0
tL Date Point of
U) ❑Transportation Shipment
Q by Common
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
Address
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2021 Registrar of Vital Statistics RP6ertf7ndrervCurtis gketranical6,Srgned)
(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:
Ii— 0
Z Date of Disposition 2 hilt( Place of Disposition I1 I JL AL_
W (address)
W
N it (section) tot number) (grave number)
0 Name of Sexton or Person in Charge of Premis 1 tea.k rint/� ^N�
(P P
W Signature , Title lIZPM
DOH-1555(07/18)p 1 of 2 •
Public Health Law Sec. 4145(2b) f _4 ?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#