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Hughes, Joan Barbara NEW YORK STATE DEPARTMENT OF HEALTH I(DF Burial — Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan Barbara Hughes Female Date of Death Age If Veteran of U.S.Armed Forces, 04/10/2021 85 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 71 Longview Drive APT 176,Queensbury Town,New York 12804 W Manner of Death � El Natural Cause 0 Accident 0 Homicide u Suicide 0 Undetermined n Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 92 ©Burial Date Cemetery,Crematory or Facility Name 04/17/2021 Pine View Cemetery ❑Entombment Address Cremation Queensbury Town,New York ElDonation ZZ 0 Removal Date Place Removed and/or and/or Held H Hold Address N 0 tl. Date Point of U) Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address 0 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 E Address CC W EL Permission-is-hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2021 Registrar of Vital Statistics Carolinextgard Border(Ekctronica/5'Signea9 (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: I— W Date of Disposition 4/1 7/2 0 21 Place of Disposition 21 Quaker Rd. Queens hu ry,NY 12804 (addressr W Mohawk 162, 163, 145, 146 5 ir (section) (lot number) (grave number) Q Connie Goedert Q Name of Sexton Person in Charge of Premises (please print) Ui Signature n/t.;.t- e .Q Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec.4145(2b) t12851 Receipt Human remains of , ; delivered on , , 20 - `view Cemetery Representing the funeral home named on burial permit ' Official Funeral Directors Reg.or License# HUGHES NAME Joan Hughes Age: 85 Lot Owner: John J & Mildred Goetz Lot# Mohawk Lot 1 62, 1 63, 1 45, 1 46 Grave# 5 Case: Concrete Died: 4/1 0/2 0 21 Interred /1 7/2 0 21 Funeral Home: Baker FH Cemetery: Pine View