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Hubert, Martha Ann NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Martha Jean Meredith Female Date of Death Age If Veteran of U.S.Armed Forces, 03/30/2021 62 Years War or Dates p:: Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident El Homicide El Suicide ElUndetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title 0 Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 163 ElBurial Date Cemetery,Crematory or Facility Name 04/03/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 CL 1-1 Date Point of U) ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above -- Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/02/2021 Registrar of Vital Statistics g06ert Andrew Curtis('ECectronicallySigned) (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: ~ �I It Z Date of Disposition y�Z I Z, Place of Disposition ►nc u___ W (address) W CCCC (section) lot number) (grave number) 0 Name of Sexton or Person in Charge of Premi es r.,},�L Sw,.�1tiT Z d (pleas*print) W Ca*A h�4. Signature Title DOH-1555(07/18)p 1 of 2 • y Public Health Law Sec. 4145(2b) 014690 Receipt 1 Human remains of •' delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# NEW YORK STATE DEPARTMENT OF HEALTH s Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Martha Ann Hubert Female Date of Death Age If Veteran of U.S.Armed Forces, 03/28/2021 91 Years War or Dates f— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 8A Swan Way, Queensbury Town, New York 12804 W p Manner of Death 0 Natural Cause ❑Accident Homicide Suicide Undetermined Pending Circumstances Investigation LU Medical Certifier Name Title Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 84 Burial Date Cemetery,Crematory or Facility Name 04/02/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held Hold Address 0 a Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/01/2021 Registrar of Vital Statistics Carolinexlrfegarrfe,Barger(ElectronicallySi'ned (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: F- Z Date of Disposition U i t j 7 I Place of Disposition 2 (address W CC (section) (lot nailer) (grave number) ( Name of Sexton or Person in Charge of Pre ices t ` Z (please print) I W Signature '� Title (Ytr4'417,4 DOH-1555(07/18)p 1 of 2 ' � 1 Public Health Law Sec. 4145(2b) C 1 Receipt Human remains of delivered on , 20 - t Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#