Brown, Gail R. NEW YORK STATE DEPARTMENT OF HEALTH _ }
Bureau of Vital Records Burial Transit Permit
Name First Middle Last Sex
Gail R.Brown Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/05/2021 85 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 44 Willowbrook Road 301,Queensbury Town,New York 12804
`p Manner of Death XI Natural Cause El Accident Homicide Suicide El Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
0 Aimee Mcmaster Nurse Practitioner,Acute Care
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 88
Burial Date Cemetery,Crematory or Facility Name
04/08/2021 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
❑Donation
8 ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
a 1-1 Date Point of
Cl) ❑Transportation
p by Common Shipment
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
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/07/2021 Registrar of Vital Statistics Caroline x(ctegarre Barber(Electronically 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 `RAIL l�
W Date of Disposition '�/g�Zi Place of Disposition �,�,�
2 (address)
W
CC N (section) A (lot number) (grave number)
SName of Sexton or Person in Charge of Premises r"�� �J""`A"f't)
Z (please print/
W Signature
�,� Title L YL1Gvy }
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 014 7 0 3 ,1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#