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Jones, Betty M it Sq NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Betty M.Jones Female Date of Death Age If Veteran of U.S.Armed Forces, 08/06/2021 92 Years War or Dates F.. Place of Death Hospital,Institution or Z City,Town or Village Bolton Town Street Address 49 Coolidge Hill Road,Bolton Town,New York 12824 pManner of Death ©Natural Cause 0 Accident Homicide 0 Suicide 0Undetermined El Pending 11.1 0 Circumstances Investigation LU Medical Certifier Name Title P Bryan Smead MD Address 9 Carey Road,Queensbury Town,New York 12804 ;; Death Certificate Filed District Number Register Number City,Town or Village Bolton Landing 5650 10 ❑Burial Date Cemetery,Crematory or Facility Name 08/10/2021 Pine View Crematory ❑Entombment Address dal Cremation Queensbury Town,New York EiDonation Z Removal Date Place Removed 2 and/or and/or Held F_- Hold Address N 0 UU)) ❑Transportation Date Point of p by Common Shipment Carrier Destination El 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 l— Remains are Shipped,If Other than Above 2 Address IX W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/09/2021 Registrar of Vital Statistics You Tetteys(f(ectronicalTy Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IL efZ Date of Disposition >S t+1f4 Place of Disposition �� d«,__ W 2 (address) W U) C (section) / (lot number) (grave number) Name of Sexton or Person in Charge of Premises e/���� � 44 Z j� (plea print) /� (W Signature L/ Title DOH-1555(07/18)p 1 of 2 - #asua311 JO•fag sJopa.IiU Ipaaund Ipiap 1 liuuad'epic{ito pauzpu auzoq imaun3 alp 2upuasa.zda21 �Cza1auzaJ main auk'� .._ f r r I 4_ OZ ' uo polo/m.40p ,� , JO suTtuaJ u1uznH i t�t Y 1dla°aX I t (gZ)S-vij '°°S isikUl uPF°H °!land d 9 OSIO f c