Hopkins, Kelly Jo Town of Queensbury 11111)
.4., Certification of Cremation
V00 Pine View Cemetery and Crematory
This certifies that the remains of: Kelly Jo Hopkins
were cremated on June , 30 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death June , 26 20 21 Age 59
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 531
(:,
(Authorized Signature)
HOPKINS
NAME Kelly Hopkins 1_71- Age: 59
Lot Owner: Marion Hopkins
Lot# Algonquin Lot 57 Sec. F Grave# 3
Case: Urn
Died: 6/2 6/2 0 21 Interred: 7/9/2 0 21
Funeral Home: Baker FH
Cemetery: Pine View
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kelly Jo Hopkins Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/26/2021 59 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
p Manner of Death ❑X Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
CI Leonard Gelman MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 45
ElBurial Date Cemetery,Crematory or Facility Name
06/29/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury Town,New York
❑Donation
ElRemoval Date Place Removed
and/or and/or Held
H Hold Address
0
a- Date Point of
co Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
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
Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/29/2021 Registrar of Vital Statistics S/iellry.fckernon(Thctronical51Signed)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 4'30ty Place of Disposition �
2 (address)
W
CC N
(section) n (!fit number) (grave number)
Name of Sexton or Person in Charge of Z (pleeae print)
W
Sinature Titleg 6emises
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) - 8 9 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#