Robinson, Elizabeth Town of Queensbury
thilAffata Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Elizabeth Ann Robinson
were cremated on September 18 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death September , 14 20 21 Age 78
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 787
7•./../i/-/
(Authfirized Signature)
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elizabeth Ann Robinson Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/14/2021 78 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
Manner of Death El Undetermined Pending
111
Natural Cause Accident Homicide Suicide 12
Circumstances Investigation
W Medical Certifier Name Title
0 Leonard Gelman MD
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed District Number Register Number
City,Town or Village Granville 5756 75
❑Burial Date Cemetery,Crematory or Facility Name
09/17/2021 Pine View Crematory
EiEntombment Address
ICremation Queensbury Town,New York
• Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
- Hold Address
0
d Date Point of
t/) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
2 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/17/2021 Registrar of Vital Statistics Jenny Linla.11Sfartelle('/?ctronicallySigned)
(signature)
District Number 5756 Place Granville, 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 91�ip z/ Place of Disposition ` �� Li v�eh) �'�•�c� )�-D
W t
(address)
W
CC (section) • (lot number) J (grave number)
c, Name of Sexton or Person in Charge f Premises iS)14- Oa - ex,C
Z (please print)
/
W Signature f 17 Title C{e�
V
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)-
Receipt
r i .
Human remains of . - � <+ _ �� � delivered on , 20
,,.amine View Cemetery Re tesenting the funeral hdme'named on burial permit
Official Funeral Directors Reg.or License#
Robinson
NAME Elizabeth Robinson Age: 78
Lot Owner: Elizabeth Robinson
Lot# Horicon 27D Grave# 2
Case: Urn
Died: 9/1 4/21 Interred: 9/2 2/21
Funeral Home: Baker FH
Cemetery: Pine View