Gregson,Carol E NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carol E.Gregson Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/12/2021 95 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
lL Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Q William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 508
❑Burial Date Cemetery,Crematory or Facility Name
11/16/2021 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
t)
0
CL Date Point of
(i) ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
❑Reinterment Date Cemetery Address
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
F. Remains are Shipped,If Other than Above
E Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/15/2021 Registrar of Vital Statistics gp6ert Andrew Curtis(ECectronicaiTySigned)
/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:
9
Z Date of Disposition jj I n Ilf Place of Disposition `l lid--iu
2. --
faddress)
W
N
CC (section) (lot n ber) C_- /grave number/
0 Name of Sexton or Person in Char Premises ri f ,..... �if
Z / ease pri /
W Signature "...._
Title C 1M` ✓t
DOH-1555(07/18)p 1 of 2
!J 5 3 4
Public Health Law Sec. 4145(2b)
Receipt
Human remains of r` delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# '