Truesdale, Brenda Darlene Z
NEWYORKSTATEDEPARTMENTOFHEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brenda Darlene Truesdale Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/25/2021 69 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Lake George Town Street Address 816 Diamond Point Road,Lake George Town,New York 12845
p Manner of Death ❑X Natural Cause Accident ❑Homicide ❑Suicide Undetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
O Eileen Spinelli NP
Address
Carey Rd,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Lake George 5651 16
Burial Date Cemetery,Crematory or Facility Name
08/27/2021 Pine View Crematory
El Entombment Address
0 Cremation Queensbury Town,New York
0 Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
U) LI Transportation
if) 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
H Remains are Shipped,If Other than Above
"_. Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/26/2021 Registrar of Vital Statistics Patricia W,(fc nneySchusterg 'ctmnicalySigned)
(signature)
District Number 5651 Place Lake George, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
Z Date of Disposition p-Z0,---7011Place of Disposition jt L J' G're-yyr, ry
2 (address)
W
CC N
(section) (lot nuer) (grave number)
O Name of Sexton or Perss• Ch of Premises "I) c. eve e
Zr (please print)
t1J Signature Title C—r//— Aflr'y �Ne �
DOH-1555(07/18)p,vof 2
'11. 508
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on - , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License# ,' $ I '_'t,