Linedoll, Laura Eleanor 2
NEW YORK STATE DEPARTMENT OF HEALTH 5'
Bureau of Vital Records
it �Burial - Transit Permi Name First Middle Last Sex
Laura Eleanor Linendoll Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/21/2021 77 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 20 Van Dusen Road,Queensbury Town,New York 12804
1p Manner of Death 0 Natural Cause 0 Accident Ei Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Paul Filion MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 77
. ❑Burial Date Cemetery,Crematory or Facility Name
03/23/2021 Pine View Crematory
ElEntombment Address
ElCremation Queensbury Town,New York
0 Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
0
CL Date Point of
(I) Li Transportation
Q 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
Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/23/2021 Registrar of Vital Statistics Carolainexldegard Barger(Ekctronica( Signed)
(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:
Z Date of Disposition 31 Z3)Z1 Place of Disposition l ��.
address)
W
CC
N (section) Ill number) (grave number)
G Name of Sexton or Person in Charge of P ises A r vxtrit
(please int)
W Signature a Title t'prso4fk
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 1-P.6 9 2
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#