Baker, Margaret Leasure NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Margaret Leasure Baker Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/04/2021 74 Years War or Dates
E— Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W
p Manner of Death 1=1 Natural Cause El Accident Homicide 0 Suicide 1:1Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
Ci Avi Alin MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number I Register Number
City,Town or Village Albany 0101 2464
0 Burial Date Cemetery,Crematory or Facility Name
10/06/2021 Pine View Crematory
❑Entombment Address
EiCremation Queensbury Town,New York
❑Donation
Zrl
Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
O. Date Point of
t!) ❑Transportation
ES 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
f.. Remains are Shipped,If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/06/2021 Registrar of Vital Statistics DDanielreScillespiegkctronicallySigned9
(signature)
District Number 0101 Place Albany, 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 /Oh(t1 Place of Disposition ul ` L s----
2 (address)
W
U)
CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of emises tu � ""l{�
Z (p/e se print)
W Signature Title C WM lf("e
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
.. 1t 212
Receipt
,i
d 1
Human remains of °�' i delivered on , 20
Pine View Cemetery Representing the funeral home named on,bprial p9rmit
Official Funeral Directors Reg.or License# '�'(