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Quigan, Dorothy Gail 4 gyel NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dorothy Gail Quigan Female Date of Death Age If Veteran of U.S.Armed Forces, 10/03/2021 92 Years War or Dates 1., Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek pManner of Death © Natural Cause ❑Accident ❑Homicide El Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Michael Miles MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 38 ❑Burial Date Cemetery,Crematory or Facility Name 10/05/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Q. Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment 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 IE— Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2021 Registrar of Vital Statistics Kutkieen C.Gorah(E1ectronica1ty Signed) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ''II W Date of Disposition /p��Ili Place of Disposition �4� �..�dr` 2 (address) W CCCC (section) A f/ot number) (grave number) It el Name of Sexton or Person in Charge of Pr mises f,4 � Z ( ease print) W Signature Title DOH-1555(07/18)p t of 2 0 1.5 3 0 9 Public Health Law Sec. 4145(2b) Receipt ... , --, Human remains of .., i , ' 7 . . . . delivered on ,, .- , 20 ---/ „ ..../ / -.'.. Pine View Cemetery Representing the funeral home named 9nburijaLpermit Official Funeral Directors Reg.or License#