Landry, Loretta NEW YORK STATE DEPARTMENT OF HEALTH ( L
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Loretta Ruth Landry Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2021 97 Years War or Dates
f. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address 277 Ridge Street,Glens Falls,New York 12804
p Manner of Death
NIW Natural Cause El Accident ❑Homicide Ej Suicide Undetermined Pending
Circumstances Investigation
WQ Medical Certifier Name Title
David Cunningham MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 501
Burial Date Cemetery,Crematory or Facility Name
11/12/2021 Pine View Cemetery
❑Entombment Address
ElCremation Queensbury Town,New York
Donation
0 ❑Removal Date Place Removed
F.: and/or and/or Held
N Hold Address
0
A. Date Point of
Cl) ❑Transportation
0 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
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 11/09/2021 Registrar of Vital Statistics 9Zo6ertAndrew Curtis(Electronically Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Il—
ILI
Z Date of Disposition 1 1 /1 2/2021Place of Disposition 21 Quaker RD. Queensbury, NY 12804
(address)
u! Huron 25 E 2
U)
Ct (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Connie Goedert
'Z �o (please print)
Signature4 )PUUJ eio Title Superintendent
DOH-1555(07/t8)p t of 2
Public Health Law Sec. 4145(2b) 012 8 81
Receipt
Human remains of t --_ r , delivered on \4_ , 20_,a
•
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
LANDRY
LF
NAME Loretta Landry ` Age: 97
Lot Owner: Loretta Landry
Lot# Huron 25E Grave# 2
Case: Concrete
Died: 1 1 /7/2021 Interred: 1 1 /1 2/21
Funeral Home: Baker FH
Cemetery: Pine View