McLaughlin, Wanda Lee itys1
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Wanda Lee McLaughlin Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/29/2021 76 Years War or Dates
ZZPlace of Death Hospital,Institution or
City,Town or Village Albany Street Address Albany Medical Center Hospital
IlJ
p Manner of Death ❑X Natural Cause 0 Accident 0 Homicide ❑Suicide 0 Undetermined 0 Pending
ILJ
O Circumstances Investigation
LU Medical Certifier Name Title
CI Jordan Roberts PA
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1418
❑Burial Date Cemetery,Crematory or Facility Name
06/01/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
f-N Hold Address
0
a- Date Point of
U) �Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name o'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
2 Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/01/2021 Registrar of Vital Statistics rDania&S yillerpie(Ekctronicall:y Signed)
(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:
Z Date of Disposition (P/3 j Zit Place of Disposition Zit it ,dh`
2 (address)
W
CC N (section) daot number (grave number)
O Name of Sexton or Person in Charge of Premise t'�+�p
Z /pleA print/
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) ' ._ -- ' _ 4 8 2 5
Receipt
delivered on 20 _
Human remains of ,
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#