Meltzer, Karen Gerstenzang St- /ttl
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Karen Gerstenzang Meltzer Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/18/2021 86 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Horicon Town Street Address 7491 State Route 8,Horicon Town,New York 12815
p Manner of Death a Natural Cause 0 Accident ❑Homicide 0 Suicide Undetermined Pending
11.1
Circumstances Investigation
W Medical Certifier Name Title
CI Suzanne Bergin DO
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Brant Lake 5654 7
ElBurial Date Cemetery,Crematory or Facility Name
11/22/2021 Pine View Crematory
0 Entombment Address
EiCremation Queensbury Town,New York
0 Donation
0 Removal Date Place Removed
and/or and/or Held
H fN Hold Address
0
11.(I) Transportation Date Point of
p by Common Shipment
Carrier Destination
0 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
5 Address
CC
111
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/22/2021 Registrar of Vital Statistics Vista L Wooar(Ekctronthall:y Signea'
(signature)
District Number 5654 Place Brant Lake, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
- t
Z Date of Disposition �I� 23 ill Place of Disposition t,y
(address)
W
OC
OC (sectbn) number) � �� (grave number)
0Name of Sexton or Person in Char a of Premises /47
Z (p/ee print) /yr,
W Signature Title ( ul(/«
DOH-1555(07/18)p t of 2
1)15 .,
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# G"