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Kaplan-Angle, Dana Edis # 3g1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dana Edis Kaplan-Angle Female Date of Death Age If Veteran of U.S.Armed Forces, 04/23/2021 33 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address Main Street,Warrensburg Town, New York 12885 • Manner of Death ❑ Natural Cause ©Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 13 ❑Burial Date Cemetery,Crematory or Facility Name 04/28/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held H N Hold Address O. d. Date Point of co Transportation O by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 1— Remains are Shipped,If Other than Above 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/27/2021 Registrar of Vital Statistics Pamela M Lloyd(ECectronicallySigned) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Z Date of Disposition //21 Z, Place of Disposition W 2 (address) W CC N (section) d(lot number) (grave number) Name of Sexton or Person in Charge of Premi s ' 1N A41 f Z (pleas print) W Signature f Title rOM DOH-t555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 14 7, 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#