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Bagley, Ann L N EW YORK STATE DEPARTMENT OF HEALTH 0,/� Bureau of Vital Records Burial — Transit Permit Name First Middle Last Sex Ann L Bagley Female Date of Death Age If Veteran of U.S.Armed Forces, 05/08/2021 73 Years War or Dates ... Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital uJ p Manner of Death ❑X Natural Cause Accident El Homicide El Suicide 0 Undetermined Pending VCircumstances Investigation LU Medical Certifier Name Title Diana Padilla Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 1191 ©Burial Date Cemetery,Crematory or Facility Name 05/12/2021 Pineview Cemetery Entombment Address 111 Cremation Queensbury Town, New York 111 Donation OZ Removal Date Place Removed and/or and/or Held Hold Address 0 d Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home New Corner Cremations&Funerals(01253) 01253 Address 343 New Karner Rd,Albany,New York 12205 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/11/2021 Registrar of Vital Statistics ,lanieIT€Sct&spie(ElectronicallySrgnea) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: If— Z Date of Disposition 5/12/2 0 21 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804 UJ (address) w Mohican 78 F 1 U) Q (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises Connie Goedert Z (please print) W Signature Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b)Receipt 012854 i ! . 1 Human remains of A 'i - : ' ' , delivered on H . , 20 , . ----- , , ',-1 k ,'''' t i ; ,N\ y Y i ' - Trine View Cemetery Representing theiiinetal home namedion hupikall permit Official Funeral Directors Reg.or License# It 1 1 I 1 , • BAGLEY NAME Ann L. Bagley / Age: 73 Lot Owner: John & Lou Ann Holt Lot# Mohican 78F Grave# 1 Case: Concrete Died: 5/8/2021 Interred)/12/2021 Funeral Home: New Corner Cremations & Funerals Cemetery: Pine View