Carpenter, Margaret Ann NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Margaret Ann Carpenter Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/09/2021 78 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Milton Town Street Address 93 Rowland Street,Milton Town,New York 12019
`p Manner of Death ❑X Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined Pending
C,) Circumstances Investigation
W Medical Certifier Name Title
Mina Sun MD
Address
115 Saratoga Road,Glenville Town,New York 12302
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 48
0 Burial Date Cemetery,Crematory or Facility Name
09/13/2021 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
z ❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
Cl) ❑Transportation
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
H Remains are Shipped,If Other than Above
a Address
W ---
0' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2021 Registrar of Vital Statistics Brenrla7fowe(Ekctronical61Signed)
(signature)
District Number 4561 Place Ballston Spa, 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 Cl/J 4/J of Place of Disposition P` V f„V (i(G,' ct lacy
W 1 1f�Cr
2 (address)
W
CC (section) (lot number) (grave number)
0 Name of Sexton or Per n in Charge of Premises � try S/'re, 5
(please print)
W
Signature Title C.,re.ynn f
DOH-1555(07/18)p 1 of 2
. . 01_514 1.
Public Health Law Sec. 4145(2b) a-- . ge
I Receipt
Human remains of i ''' , ' - i st delivered on , 20
Pine View Cemetery ,,,-/ ..- -
,'
Representing,*funeralhome named on burial permit
Official Funeral Directors Reg.or License# , • 't 1 er